October 6, 2025 • 36 mins
We always hear “get your mammogram,” but what about your thyroid, vitamin D, iron, or even your bones? If you’re over 40, this convo can change how you advocate for yourself at the doctor’s office.
This episode kicks off a special series with Dr. Kudzai Dombo, MD, FACOG, MSCP—a board-certified OB/GYN and menopause expert with 20+ years devoted to women’s health. Dr. Dombo has practiced and advocated for women across the globe and now focuses on supporting women through perimenopause, menopause, and beyond.
Today, we start with the baseline labs and screenings every woman over 40 should know—plus how to read your risk, when to push for more, and what to ask when guidelines don’t tell the whole story.
Get your FREE Grown-Ass Woman Health Cheat Sheet!
What you’ll learn
- Breast & cervical screening basics: When to start, how often, and when you can stop (mammogram, Pap + HPV).
- Colon cancer screening: Why guidelines moved from 50 to 45, and what “earlier” looks like with risk factors.
- Annual exam ≠ Pap only: Why pelvic exams, symptom checks, and imaging still matter—even if your Pap is spaced out.
- Heart health numbers that matter: BP, lipids, A1C, waist-to-hip ratio (and why CVD is the #1 killer of women).
- Thyroid & vitamin D: How low thyroid and low D can mimic menopause symptoms (fatigue, hair loss, temperature issues).
- Ferritin/iron: Why checking iron stores can explain hair loss and exhaustion.
- CMP/CBC: What these panels reveal about liver, kidney, anemia, and overall health.
- Lipoprotein(a): The one-time, genetics-based test that can change how tightly your BP and cholesterol are managed.
- Bone health reality check: Why waiting until 65 for a DEXA scan isn’t cutting it—and options if insurance says no.
- Personalized care: Why population guidelines are a starting point—not the finish line—especially for Black women and others with different risk profiles.
Download the companion resource: Your Health After 40: The Grown-Ass Woman’s Cheat Sheet — a one-pager covering screenings, hormones, supplements, and vaccines.
About our guest:
Dr. Kudzai Dombo, MD, FACOG, MSCP, is a board-certified obstetrician-gynecologist and menopause expert with 20 years of experience dedicated to women’s health. Known for her deep commitment to both individual care and global health advocacy, she brings a unique cross-cultural perspective shaped by her upbringing in the U.S. and Zimbabwe.
Her career has spanned continents, with work for Doctors Without Borders and NGOs in Sri Lanka, Cambodia, El Salvador, South Africa, and Haiti, where she has advocated for women at every stage of life. In recent years, she has focused her practice on supporting women in midlife and the menopausal transition, most recently as a practicing physician and Director of Advocacy and Outreach at Alloy Women’s Health and Akasha Center for Integrative Health.
She is currently a fellow of the American College of Obstetrics and Gynecology, a Diplomate of the American Board of Obstetrics and Gynecology, a Menopause Society Certified Practitioner, and a member of the International Society for the Study of Women’s Sexual Health.
She loves the creative arts, enjoys traveling, and appreciates time with her family.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
They always tell us to get ourmammograms, but we don't often hear
talk about our thyroid,vitamin D or even our bones.
If you're a woman over 40,this conversation could shift how
you advocate for yourself atthe doctor's office.
Welcome to the Grown AssWoman's guide.
I'm Jackie McDougall.
This episode is part of aspecial series with Dr. Kudzai Dombo,
(00:24):
a board certified OBGYN andand menopause expert with 20 years
of experience dedicated towomen's health.
Dr. Damba's career has spannedcontinents where she's advocated
for women all over the world.
Now she focuses her practiceon supporting women in midlife and
the menopausal transition as apracticing physician and director
of advocacy and outreach atAlloy Women's Health and Akasha center
(00:47):
for Integrative Health.
Throughout this series, we'rebreaking down everything you need
to know in midlife, fromprevention and screenings to hormone
therapy, supplements and vaccines.
Today, we start with thebasics, the screenings and labs every
woman over 40 should know about.
Dr. Dambo is an incredible OBGYN, but she's also someone who has
(01:08):
done the extra work to educateherself and her patients about what
really happens to our bodiesin perimenopause, menopause and beyond.
There are a lot of things thatas an OB gyn I hadn't been educated
on and it was a massive selfeducation for myself to be able to
(01:29):
identify.
Okay, prevention is soimportant and we don't talk enough
about it or we at least don'texplain the why.
Right.
Because I think when weunderstand why, when an individual
knows why, they're moreinclined to change their behavior.
If I know why I'm exercising, right?
Yes, it's, it's kind of wildbecause I think growing up Gen X,
(01:52):
it was like, do this, don'task questions, you know, just, just
fall in line.
Yeah.
And now, you know, we're at acertain age and you know, some of
us have raised kids and wehear that this, you know, Gen Z,
they won't do anything withoutasking why, you know.
Yep.
And I think we're just like,oh, wait a second, maybe they have
(02:14):
something there.
Maybe we don't have to justfall in line.
We can question the experts.
We can understand our ownbodies and advocate for ourselves
in a way that's very differentfrom how we were raised.
And that's 100% because I seesome of my patients who are in their
60s, right.
Like over 60 and 70s, and theyfeel like there's been A disservice
(02:36):
for them after the WHI studywhere they were denied hormones.
And now they are actuallystarting to ask those questions because
they're empowered by seeingthat, wait, a lot of people aren't
taking this laying down.
I don't want to just assumethat I am, you know, I'm no longer,
you know, a candidate or thismay not necessarily apply.
(02:58):
So it just involves a moredeeper and nuanced conversation based
on where they are, you know,and what risk factors they have.
So I think that is what I'mseeing overall, is that, yes, our
patients who are, you know,who were denied hormones at a particular
time when they were probablysuffering the most, they're now starting
to say, I want this.
(03:19):
When we talk about screeningsin labs, those are the baseline,
the tests every woman needs.
Anything beyond that should bediscussed with a health professional.
It is important to recognizethat medicine is not one size fits
all.
Menopause can look verydifferent depending on who you are
and also how you're treated.
(03:39):
Studies have shown thatspecifically black women go through
menopause earlier, haveperimenopausal symptoms longer, and,
you know, they have a higherrisk of some of the long term, chronic
conditions than, you know,other groups.
So it really became veryimportant to me as a mission to be
(04:01):
able to bring thatconversation to all women.
A lot of doctors who may bedismissing these symptoms aren't
aware of the profounddifference when it comes to long
term and chronic healthbenefits that black women may experience
by starting hormone therapy orat least being educated about the
option during the earlierstage right before they've gotten
(04:23):
down to like full blown menopause.
And I'll tell you this oneother thing, Jackie, because I think
it's really important when itcomes to black women specifically,
because again, there is a lotof mistrust with the medical system.
Right?
So I had another patient who Istarted her on the patch and progesterone
testosterone, and she ended upgoing to her primary care physician
who basically told her, I amnot talking to you.
(04:45):
Her primary care physician was.
Was also African American.
I am not talking to you aboutthis because our ancestors didn't
use this stuff.
So I am not counseling you on it.
Thankfully, that patient cameback to me and said, okay, my doctor
started me on a blood pressure med.
Is it okay for me to continueon my hormone therapy with this blood
pressure med?
Because my doctor wouldn'ttell me that is a level of trust.
(05:05):
Because that's another reasonright there where she could have
been like, no, yeah, you're acomputer doctor.
I don't know you yet.
My primary doctor.
I see her in person.
So, you know, it's really.
You feel like you're making abig difference.
Speaking of computer doctors,virtual care is on the rise.
Telehealth companies focusedon midlife women's health are growing
fast because the demand forpersonalized, accessible menopause
(05:29):
care is bigger than ever.
And the best part is you canget it all from the comfort of your
home.
But is this kind of care onlyfor the wealthy, or is it truly accessible
to all?
I've had women across theboard, right?
The women who come and they'relike, you know what?
Give me everything, and, youknow, money is not an issue.
And then I have other womenwho come who are like, hey, I really
(05:52):
want to, you know, use my insurance.
I want to be able to figure it out.
But I think one thing that isso great about the Alloy platform,
and I hear this from a lot ofpatients, is that you're getting
a response from your clinicianabout any issue that you're having
within a short period of time, right?
It's not this situation whereyou put a message into your doctor
(06:13):
who's taking care of multipleother issues, right?
A lot of us are primarilyfocused on this stage in life, and
so, you know, we're able torespond within a reasonably short
amount of time.
Sometimes it can be a fewhours, sometimes it can be a little
longer, but we're respondingin real time to the concerns.
And I find that a lot ofpatients find so much value because
(06:34):
I've had patients on the Alloyplatform who said, I want to go take
this prescription to my doctorand prescribe it.
And we have just a policywhere we say, if you're going to
do that, you can definitely do that.
However, we want to make surethat you have access to this 247
doctor messaging, as well asbeing able to if there are any issues
(06:56):
with shortages.
We have been really successfulin being able to make sure that there
is no interruption, you know,for patients, you know, when shortages
in certain forms, like theestradiol patch, we have been very
fortunate in being able toassure patients that they will have
continuity.
The only thing is, we may notnecessarily be able to say that you'll
(07:17):
get the same manufacturer, butwe really make sure of that.
And then I think of otherplatforms that do take insurance.
I think it's just I've had somany patients say the fact that I
can be on my lunch break or inmy office when I take a break and
I can just kind of do all thisstuff, fill it out.
I get an answer.
When I'm on my way home, Inotice the doctors messaged me.
(07:38):
By the time I get home, I canmessage back, answer any questions,
and then, boom, it's deliveredto my door.
I think we have transitionedfrom a very simple system barrier,
right?
Like the system of medicinethat has a lot of barriers when it
comes to getting what we need,to a system where access.
(07:58):
Being able to talk to yourdoctor directly, being able to get
an answer from your doctor,being able to know that I can get
my prescriptions shipped to me.
If there's a mistake, I cantalk to the support team.
It's really a big team thatworks together, and everybody's taken
care of a specific aspect tomake it so that the experience for
the customer or the patient,we call the patient.
(08:21):
But obviously on the otherside, it's the customer experience
for my patients is taken care of.
Like, if there's any error,any issue, boom, I can reach out
to support.
They can get that message quickly.
They go to the pharmacy, andit's taken care of.
And I think that's what I loveabout being in a system like this
versus being in a structurewhere we're dealing with an insurance
(08:43):
company and, you know,preauthorization, this is not covered.
We bypass all of that.
And you can't get in for sixmonths if you make an appointment.
And I've had patients who comeand say that I couldn't get in for
six months.
I am dying.
Please at least get me inuntil I can see my doctor.
Yeah.
So it's providing a real service.
And there's some people whoare in remote areas.
(09:05):
Like, I have patients who arein remote areas, and they don't have
access to menopause trainedphysicians in some of those remote
areas.
So, you know, I have licenses,you know, in 20 different states.
So I get to see patients in 20different states.
And so I have a patient in Maine.
You know, I have a patient inArizona, and I know them, and I appreciate
that.
Even with this platform, thatability to connect and know my patients,
(09:29):
I mean, they'll send meselfies and like, Dr. Do, this is
how I look today.
I just wanted to, you know,because there's that desire to connect,
and they figure out how toconnect with us in some way.
Yeah, that's amazing.
All right, let's get into the basics.
These are the screenings andlabs every woman over 40 should know
about.
Don't worry.
I know it's a lot to keeptrack of.
So I've put together a simpleguide, kind of a cheat sheet with
(09:52):
everything we cover in this episode.
You'll find the link whereveryou're listening or watching.
So let's talk about just someof the general screenings that we
recommend for all women over 40.
So one of the things, I mean,the main thing we recommend, at least
the American College ofObstetrics and Gynecology, is a screening
mammogram.
Right.
And this just gives you yourbaseline risk for breast cancer or
(10:14):
any type of breast conditions.
And this is recommendedstarting at age 40, and we recommend
it every one to two years.
If you have no risk factors.
If you have risk factors, itmay look a little different.
And when I talk about riskfactors, it could involve, like,
family history.
It could be of, you know,breast cancer diagnosed at a young
(10:35):
age.
It could mean that you've had,you know, the BRCA gene or some other
gene, because there's, youknow, the check 22 mutation.
There are all these differentmutations that are there.
So, you know, it may mean thatyou get your mammogram earlier.
It may mean that you getadditional testing, like you get
an mri or you end up getting amammogram, you know, with ultrasound,
(10:57):
or you just maybe get morefrequent testing.
Right.
So it really depends on whatyour risk factors are.
If you have absolutely no riskfactors, you're really looking at
getting a mammogram every oneto two years, at the very least,
starting at age 40.
Okay.
Okay.
And that's one screening test.
Is there a time where you stopgetting mammograms?
So the number that has beenquoted is 75.
(11:19):
If you have any form of riskfactors, like if you are on hormone
therapy, like, I personallywill continue with my patients.
But it's obviously aconversation between the two of us
because there are somepatients who are just like, absolutely
not.
My role, my responsibility isto arm you with the guidelines, give
you the information, and I cangive a recommendation.
(11:40):
At the end of the day, it'sreally like the patient autonomy.
And then the next thing weknow of is the Pap smear.
And, you know, before the ageof 21, we typically don't recommend
a Pap smear being done.
But once you get to the age of21, that's when we start 21 to 29,
we look at doing a Pap smearwith an HPV every three years.
(12:02):
Okay.
Versus what we used to dobefore, which was every year.
And I think it's important toidentify that the combination of
the Pap.
And the HPV has increased thesensitivity of the test.
And that's why we've kind ofspaced out the time frame.
Because not only that, butalso when you're in that early age
group, 21 to 29, you're moreinclined, if you do have HP, to shut
(12:26):
it, like your immune system.
And your body is very strong.
And hpv, even if it does leadto some lesions, your body tends
to really shut it.
So that's why age 30 to 65.
Now we start recommending youcould do the HPV along with a Pap
smear.
And that's done every five years.
(12:47):
So it's important to realize that.
And this is where I think itbecomes a little tricky because patients
start to think, oh, I don'tneed to go to the doctor for five
years, which is not the case.
You know, it's not the case at all.
It's really important that youare going because, you know, when
you go for your annual exam,we're screening you as well for like,
are you having any irregular bleeding?
What are your periods like?
(13:07):
And are you having bleedingafter intercourse?
And sometimes some of theanswers to those questions may mean
that we need to do, you know,additional, you know, additional
screening or additional testing.
We also, it's important for usto do a pelvic exam so we can feel
your ovaries, feel youruterus, does it feel enlarged?
You know, and that helps alsoguide us and determine whether or
(13:28):
not we need to do additionalimaging, like an ultrasound, endometrial
biopsy.
There's just a lot ofdifferent things that we're looking
for.
And it's not just confined to,you know, your Pap smear.
Right.
And then is there an end whereyou stop getting a Pap?
You know, I mean, I guess ifyou don't have a cervix.
Right.
Like, that's.
Yeah.
(13:49):
So if you've had it.
If you.
Absolutely.
If you've had a hysterectomyand you have had no risk factors.
Right.
So your Paps have been fine.
Like, you've had no risk factors.
You do not need a Pap smear anymore.
If you are 65 and over andyou've had no risk factors, you definitely
can stop getting your Pap atthat age.
(14:10):
Okay, good to know.
And that those are just someof the, you know, the guidelines
that we go by.
And I think it's important tooto remember that these are population
based guidelines.
Right.
And, and I think it's reallyimportant, especially for women to
identify, like, if I'M feelinglike something's not right, you know,
and, you know, in my body, Istill tell my patients to bring it
(14:33):
up and ask, you know, if thatis something, because you know your
body better than we do.
And we're going based onpopulation numbers and not, you know,
individual, you know, people.
And then there's the dreaded colonoscopy.
Everybody talks about thatprep, but I promise you, it's not
that bad.
I've had a few.
(14:53):
But when should we expect toget our first?
So if you have no.
No risk factors, no familyhistory, we say age 45.
Okay.
And I think it's important torecognize because for a long time
it was age 50, and I thinkwith a lot more younger people being
diagnosed with corporations,colon cancer and later stage colon
(15:15):
cancer, and they looked at thestatistics and they changed the guidelines
and basically said 45 is whenit's recommended to start having
a colonoscopy.
I waited until 50 because Ijust, I. I did because I just, you
know, it's the mind.
It's like thinking about theprep, thinking about the whole procedure.
(15:35):
It just took me a little bit.
But I do tell my patients 45as know what the guidelines are.
And I think the beautifulthing about that is if it's normal,
it's every 10 years.
So, you know, unless they finda polyp, unless they find something
that may be concerning, it'sat least every 10 years.
And it's reassuring when youcan get a negative one because you're
(15:56):
like, okay, I've done that.
Like, if there changes in mybowel habits, which can occur during
the perimenopausal transitionand into menopause, your bowel habits
can change.
But I always say that it is soreassuring to be able to know that,
okay, I've had a colonoscopy,and I know that there is nothing
pathological going on.
Every individual is different.
Okay, you smoke, you may haveanother history.
(16:16):
Like, it may be worth having acolonoscopy done before age 45.
But I think you would reallyhave to tease out your individual
risk factors.
But definitely, if you alreadyhave chronic disease within your
GI tract, you are already acandidate or somebody who.
It is recommended to have acolonoscopy sooner.
That makes sense.
(16:37):
As a side note, it's importantto be honest.
They ask if you smoke, theyask if you drink, they ask, you know,
about sexual partners or whatever.
I can only imagine from yourside, people don't want to be judged
or perceived as something.
What would you say to thosepeople who are just.
They don't want to necessarilygive all the information.
(16:57):
This is something that comesup for me all the time, because as
an OB GYN, right.
STDs are one.
You know what your history is.
And sometimes it may beimportant that if there's somebody
else in the room, I just havethem step out.
And I think it's important.
The other area where I findthat people have a tendency to lie
is when it comes to justsubstance abuse.
And here's how I frame it.
(17:17):
When I ask the question, and Ijust said, you know, this is a question
I ask everybody, and I'masking so that I can actually be
able to help you.
And I want you to be able tofeel comfortable, to be able to be
honest with me.
So I think when you preface itlike that, because that it's a space
of no judgment.
It's really like clinicalinformation that will help me be
(17:38):
able to help.
Come up with the besttreatment plan for you.
They tend to be a lot morewilling to tell the truth, but it
takes years of doing this and,you know, knowing that there are
a lot of people who don't wantto admit to any substance abuse,
and if they do, they want toerr on the side of, like, even less
than, you know, what they maybe taking at the time.
(18:00):
If the patient feels thatthere will be no judgment, I think
it's easier for them to beable to open up.
Absolutely.
It's like when they ask aboutyour weight on your license.
Why.
Absolutely.
We all.
That's another area that isdefinitely another area that it can
become.
Because usually, like, when Iwas in the hospital, they get weighed,
(18:22):
or we have it in their clinic chart.
Right.
But it's definitely, you know,because we get records.
Right.
So they're weight at their offices.
So it's.
It's not anything that I'veever had to navigate until I was
doing telehealth.
And I have to ask.
And some patients refuse toput their weight on their intake
forms.
But I think when peopleunderstand the why, it makes it a
little bit more helpful forthem to be a little bit more open.
(18:45):
What are some of the reasonsthat you would want to know somebody's
weight?
So, I mean, this is a segmentinto heart health, which is beautiful
because one thing that it'snot stressed to us women is the number
one killer for women iscardiovascular disease.
And what I tell patients and Itell myself this is.
(19:08):
It's so important to know your numbers.
Right.
Because there are specificrisk factors for cardiovascular disease.
And when you know what yoursare, we can look at mitigating them.
And so either your bmi, which,that's another metric that's probably
going to be going away soonbecause we're going to be looking
at body composition.
But right now, what we have togo with overall is just a bmi, which
(19:29):
is really takes into accountyour height and your weight.
If you know that number, youknow where you kind of fall into,
if it's normal, if you'reunderweight, if you're overweight,
or if you're obese.
And that is a known riskfactor for cardiovascular disease.
But not just that in isolation.
Right?
So I tell patients it's notjust your bmi, but I'm also interested
(19:51):
in your hip waist circumference.
And what that is, is you takea tape measure, you measure the thinnest
part where your belly buttonis around, you know, your waist,
and then you go to the widestarea around your hips, and we look
at that ratio and that givesus a sense if it's above 0.8, it
tells us whether or not youhave a lot of visceral adipose fat
(20:12):
around your organs.
So if we know that you have alot of visceral fat around your organs,
especially your heart, that isanother risk factor for cardiovascular
disease.
Right?
So knowing what that numberis, knowing what your blood pressure
is, you know, I like, okay, itwas taken at the doctor's office.
I don't know, they told me itwas normal.
But knowing where you are inthe spectrum is important.
(20:35):
Even if you are normal and ifyou are borderline, knowing that
you're borderline, and even ifyou go to the doctor's office and
they tell you your number,asking, hey, where does that stand?
You know, where am I?
Am I in the good range?
Am I in a borderline rangewhere that's something to be concerned
about?
And obviously if you're in ahigh range, I'm thinking they would
(20:57):
tell you.
But I think it's important forus to know our numbers, right?
So it's think of your highblood pressure, you think of your
lipid panel.
What is your cholesterol value?
Right.
I think as a doctor, you know,I kind of would be like, oh, I have
a vague idea.
But, you know, I never reallytook this on as being in charge of
(21:18):
my cardiovascular health.
So it was just like, okay, youknow, what is my test result for
prediabetes?
Am I far away from that?
Am I close to it?
Am I pre diabetic or am I fullblown diabetes?
Right?
So we have a test called.
It's a diabetes screen.
It's a hemoglobin A1C.
So it tells you what yourblood sugars have been doing over
(21:40):
the last three months.
That is another key, importantmetric when we're looking at heart
health, because we know thatwhen you go through midlife and you
have this shift in hormones,you develop a level of insulin resistance
that's important to screen forbecause it's profoundly impacted
by when your hormone levels shift.
And then being able to know,like, your lifestyle, what is the
(22:02):
quality of your sleep, how areyou managing stress, what is your
nutrition like?
So when you ask thosequestions, it really gives you a
clearer picture of what yourparticular risk factors for cardiovascular
disease are.
And that should be like,something that we all know, because.
Right.
If that's the number onekiller of women, why wouldn't we.
(22:24):
Right.
And does that require going toa cardiologist?
Or we can get that as just ageneral well visit.
General well visit.
You can get that either atyour primary care doctor when you
go in for your gynecologistfor your annual exam.
We've covered the bigscreenings and heart health.
Now let's move into the restof the blood work that's important
(22:45):
to look at, starting with your thyroid.
A thyroid function panel.
Like, it's really important toget that done, because I think if
your thyroid levels are low,that can mask many different conditions.
And if we don't know that yourthyroid has been assessed and we
can get you back to feelingmore like yourself, that is a huge
(23:07):
part that could potentially be missed.
So, you know, your thyroid isresponsible if you're fatigued, if
you feel like havingdifficulty with temperature regulation,
hair loss.
These are all common symptomsthat can occur during midlife.
But again, thyroid can be oneaspect that's contributing, you know,
or it could be just yourovarian hormones.
But it's really important thatwe can eliminate that as a potential
(23:32):
cause for symptoms, by the way.
And it also may cause weight gain.
And these are really profound,bothersome symptoms that occur during
perimenopause and menopause.
Right.
Vitamin D level is another onethat's really important.
And I always say, like, abaseline blood count, which is what
we.
A cbc, which is just yourgeneral blood count that tells us
(23:53):
whether or not you're anemic.
Because, again, if you'rehaving symptoms of fatigue, it's
important for us to know oreven to get a baseline and then,
you know, a complete metabolicpanel which tests for your kidney
function, your liver function,Just to get a sense of what chemically
is going on in your body.
Are these organs functioning normally?
Are they sluggish?
(24:13):
Are we seeing things that wemay not have known, you know, like
your liver function?
They're elevated.
Then we can kind ofinvestigate and look at why.
Why is your liver functionsuboptimal at this point?
Have you been exposed tohepatitis B or hepatitis A or any
condition that could impactyour liver function?
Ferritin is another good testto do in midlife, and it tests our
(24:35):
ability to store iron.
And that's important becausehair loss, like, if you're iron stores
are low, it can contribute tohair loss.
And I think when we go throughthat transition, we're trying to
figure out what is causing myhair loss.
And also, like, is it my hormones?
Is it this?
Is it my thyroid?
Because thyroid can also cause that.
(24:56):
It's important to kind ofscreen for ferritin levels.
Your iron stores, do you haveadequate iron stores?
Because that'll also helpeliminate some symptoms that you're
having or how we can come upwith a treatment plan that applies
to you.
Right.
I could see how easy it couldbe to, like, brush off a lot of these
symptoms as just perimenopauseor menopausal symptoms, because it's
(25:16):
like, here you have yourcategory of menopause, and then here
you have your thyroid iron.
All of these over here, andthey mirror, they resemble each other.
And so I'm assuming it'sreally important to just not disregard
symptoms and just go and getit checked out.
Yes.
And this is why I tell allpatients, just get your screening
(25:37):
labs and make sure that we'velooked at all of these things and
know that we're not looking atany other deficiencies that could
be contributing to symptoms.
Because this is foundationalwhen it comes to being able to really
make a diagnosis.
Right, right.
Because we know perimenopauseis a clinical diagnosis.
And so we look at symptoms, welook at patterns.
(26:00):
So it's not like there's atest for us to do that'll be like,
oh, and this is why it's sohard, I think, for women sometimes
to be able to understand,wait, well, aren't you going to check
my hormones?
Because, like, if it.
If.
If like diabetes, this numbermeans this, this number means this,
this number means that.
And unfortunately, it's notthat simple.
So it requires just a littlebit more explanation so that patients
(26:25):
understand how we look ateverything together to be able to
determine what we do.
So there's another test whichI Recommend to patients, if you can
get the ones that I talkedabout foundationally, that's great.
But there's another testcalled lipoprotein A, so it's lp.
And the reason why I includethis, it's a one time test.
(26:45):
It's not something that youget done like every couple of years.
It's just done once in your life.
And what that is, it's agenetic, it tells us your genetic
risk for cardiovascular disease.
Do you have any intrinsicgenetic risk for developing cardiovascular
disease?
And so why that's of benefitis because you get to work very closely
(27:05):
with a cardiologist.
Right.
Or you get to work with maybeeven a PCP to make sure that your
numbers are dialed in, yourblood pressure, your cholesterol.
Like, we're not just beinglike, you're a little close here,
you're a little close there.
No, that really helps yourdoctor identify whether or not your
numbers need to be dialed in alittle bit more.
(27:27):
Like if your blood pressure isout there.
No, we need to have you comeback next week.
And if lifestyle changes,don't change it, we will need to
put you on something to helpmanage that because we cannot afford
for you with this elevatedlipoprotein A to have your numbers
kind of, you know, becauseyou're just a higher risk.
(27:48):
Yeah.
And so is that a test that alot of doctors are aware of, giving
and also is it covered byinsurance typically?
So that is a wonderfulquestion because I was not aware
of it until a couple years ago.
And so I think this is the thing.
As we really look at theoverlap from cardiologists, from
(28:10):
knowing the joint, like themusculoskeletal syndrome of menopause,
as we learn how to reallyimprove and impact women's health,
my colleagues who are OBGYNsand who aren't specializing in midlife,
they don't know because we'renot taught.
We're not taught.
Unless you are in rooms withprimary doctors, like right now,
(28:32):
the space for taking care of women.
Like, they're orthopedicsurgeons who've carved out a niche,
they're PCPs, they're family doctors.
So when we come together witha confluence of all this information,
they're cardiologists, weelevate and we educate each other
and elevate so that peoplelike me who want to do best for patients
(28:54):
are able to know that, ah,that's something that I need to look
at, educate my patients and,you know, move it forward.
My OBGYNs at the hospital whoare doing Deliveries.
I'm not going to say all ofthem, but very few of the ones that
I worked with are aware of it.
Wow.
Yeah, that's wild.
And this is just according tothe American College of Obstetrics
and Gynecologists, if you'venever had these two tests ever done
(29:17):
before, it really is importantto have them done at least once in
your lifetime.
An HIV and a hepatitis D. Soif you've never had these done in
your lifetime, it's consideredat least once in your lifetime to
be screened for that.
These are some things, youknow, if you are getting screening
labs from your pcp, your OBGYN can order these labs.
And they're very basic, like,this is the low hanging fruit.
(29:40):
This isn't anythingcomplicated, anything beyond this,
because there's so many other tests.
Right.
But I'm just talking at like,what is it that is the foundational,
the easy things to look at,because I think sometimes it's very
easy to be overwhelmed with alot of information that's out there.
And then we start to wonder,okay, well, do I need this?
(30:01):
Do I need this?
Do I need this?
I'm just trying to keep it simple.
Screenings, heart health,blood work, check.
But there is another area thatoften gets overlooked.
Our bones.
Let's talk about the bones.
Because I have had countlessconversations with women, just in
my experience, the mostignored, like most of the women that
(30:24):
I talk to.
And I've said, have you everhad a scan?
They're like, no, never.
Is it just because I'vepostmenopausal for so long?
Or should we all be gettingthese bone scans?
So here's what the guidelinessay, and I'm going to put that caveat
there because we're in an erawhere the guidelines no longer reflect
(30:46):
all the information that hasbeen gathered, all that we know so
far for women who are inperimenopause and menopause.
So the guidelines essentiallyindicate that a DEXA scan is indicated
at age 65.
Okay.
And if you think about it, byage 65, I think we can make a lot
of change occur before then.
(31:06):
If we knew, right?
If we knew our bones werethinning, if we knew that we had
osteopenia by age 65.
I think we're now looking ateither pharmaceuticals or some women
may not want to start estrogentherapy that late, you know, considering
it's outside the window.
But so I think we are in aspace where the guidelines have not
(31:29):
caught up with what we knowabout what the changes that occur
in women's bodies.
Right.
The only way that you can getan insurance to cover a bone scan
before age 65.
Two reasons.
If you personally have hadmenopause before age 45.
Right.
If you have had surgicalmenopause or premature ovarian failure
(31:50):
or something, or earlymenopause Prior to age 45, you are
definitely a candidate for aDEXA scan.
Or if you had a family historyof osteoporosis.
And I know the temptationwould be, okay, well, I'm just going
to say that I have a familyhistory of osteoporosis so that I
can get it approved.
And yet, you know what?
We shouldn't have to do that.
I mean, I think what I tell mypatients these days, it's either.
(32:15):
There are usually great out ofpocket contracted rates for people
to get a bone density scanthat may not necessarily be covered
by insurance.
But I recommend at leastgetting a baseline or even one where
once you are at that point ofmenopause, like you've gone through
the 12 months, I mean, even inperimenopause, getting at least a
(32:38):
baseline so you know where you are.
Right.
Because I think when we'reinformed, when we know what's going
on in our bodies, we're moreinclined to make the changes necessary
than.
And like with the resistance training.
Right.
Okay.
I know my why.
My why is because of my bones.
I want to be able to reduce myrisk of a fracture.
I find that women tend to bemore powerful when they are very
(32:58):
clear on their why.
So I think there is no costthat I would put when it comes to
my health and being able tounderstand what's going in my body.
However, I think one of thethings that we are advocating and
fighting for is for thatguideline to be changed.
Absolutely.
(33:18):
And if you can't get itcovered by insurance, really being
able to look at what programsare available to be able to get a
DEXA either at the least costpossible, or talk to your insurance
rep to see if there's a waythat your insurance would be willing
to do it.
But I think again, I don'tRecommend waiting until 65 for my
patients.
I tell them to get it done sooner.
(33:39):
Yeah, yeah.
So I'm not a doctor, so I'mnot held to the same standard you
are.
Um, so I just lie if I feellike I need to have something checked.
And I like, I trust my gut, myspidey sense.
I recently got a Covid boosterand I don't have any of those, you
(34:02):
know, under 65.
Listen, if there were a shortage.
Yeah, I would not do thatbecause I don't want to take medicine
away from somebody.
Like, that's.
That's not what I'm looking to do.
But that's not the case.
We just have some people incharge who think that they know best.
I also have, you know, familymembers who have very delicate situations
and they live in my house.
(34:22):
And so, yeah, if I can preventgiving them something.
So anyway, so listen, that.
That's why I do.
I go, wink, wink, wink.
Family history.
Osteoporosis is a reason toget it covered.
Yeah.
And I don't think they'resending out a detective to determine
whether or not that issomething that's true.
(34:43):
Wink, wink.
We'll just go with that.
When it comes to protectingour bones, there's a simple daily
step that can make a big difference.
And it might not be what youthink it is.
So I think I want to mentionone specifically relating to just
our conversation about bone health.
It's really like getting avitamin D level because I think it's
really important.
(35:03):
We all think about calcium.
Calcium.
Calcium in our bones.
Right.
But I think it's important toremember that vitamin D, it's responsible
for helping that calciuminterchange with your bones.
And so I always make sure thatI identify what your vitamin D level
is because it's very importantto know, hey, are you deficient?
And if you are, it isimportant to supplement because we
(35:26):
want to maximize on your bone health.
Right.
So it's going to be theresistance, exercise, training, having
protein in your diet, but alsovitamin D. So that's just to complete
that bone health.
I walked away from thisconversation with a checklist and
a whole new level of clarity,but it's a lot of information.
So to make it easier for youto take charge of your healthcare,
I've created a simple healthcheat sheet with all the screenings
(35:48):
and labs we covered today, aswell as info on hormones, supplements,
and vaccines that we'll coverlater on in the series.
I'll provide the link whereveryou're watching or listening.
And remember, this is just thefirst in the series with Dr. Dambo.
You don't want to miss what'scoming next.
So hit subscribe and turn on notifications.
If this episode was helpful,please share it with a friend because
(36:11):
every grown ass woman deservesto feel informed, empowered, and
supported.
Until next time.
You are a grown ass woman.
Act accordingly.
They always tell us to get ourmammograms, but we don't often hear
talk about our thyroid,vitamin D or even our bones.
If you're a woman over 40,this conversation could shift how
you advocate for yourself atthe doctor's office.
Welcome to the Grown AssWoman's guide.
I'm Jackie McDougall.
This episode is part of aspecial series with Dr. Kudzai Dombo,
(00:24):
a board certified OBGYN andand menopause expert with 20 years
of experience dedicated towomen's health.
Dr. Damba's career has spannedcontinents where she's advocated
for women all over the world.
Now she focuses her practiceon supporting women in midlife and
the menopausal transition as apracticing physician and director
of advocacy and outreach atAlloy Women's Health and Akasha center
(00:47):
for Integrative Health.
Throughout this series, we'rebreaking down everything you need
to know in midlife, fromprevention and screenings to hormone
therapy, supplements and vaccines.
Today, we start with thebasics, the screenings and labs every
woman over 40 should know about.
Dr. Dambo is an incredible OBGYN, but she's also someone who has
(01:08):
done the extra work to educateherself and her patients about what
really happens to our bodiesin perimenopause, menopause and beyond.
There are a lot of things thatas an OB gyn I hadn't been educated
on and it was a massive selfeducation for myself to be able to
(01:29):
identify.
Okay, prevention is soimportant and we don't talk enough
about it or we at least don'texplain the why.
Right.
Because I think when weunderstand why, when an individual
knows why, they're moreinclined to change their behavior.
If I know why I'm exercising, right?
Yes, it's, it's kind of wildbecause I think growing up Gen X,
(01:52):
it was like, do this, don'task questions, you know, just, just
fall in line.
Yeah.
And now, you know, we're at acertain age and you know, some of
us have raised kids and wehear that this, you know, Gen Z,
they won't do anything withoutasking why, you know.
Yep.
And I think we're just like,oh, wait a second, maybe they have
(02:14):
something there.
Maybe we don't have to justfall in line.
We can question the experts.
We can understand our ownbodies and advocate for ourselves
in a way that's very differentfrom how we were raised.
And that's 100% because I seesome of my patients who are in their
60s, right.
Like over 60 and 70s, and theyfeel like there's been A disservice
(02:36):
for them after the WHI studywhere they were denied hormones.
And now they are actuallystarting to ask those questions because
they're empowered by seeingthat, wait, a lot of people aren't
taking this laying down.
I don't want to just assumethat I am, you know, I'm no longer,
you know, a candidate or thismay not necessarily apply.
(02:58):
So it just involves a moredeeper and nuanced conversation based
on where they are, you know,and what risk factors they have.
So I think that is what I'mseeing overall, is that, yes, our
patients who are, you know,who were denied hormones at a particular
time when they were probablysuffering the most, they're now starting
to say, I want this.
(03:19):
When we talk about screeningsin labs, those are the baseline,
the tests every woman needs.
Anything beyond that should bediscussed with a health professional.
It is important to recognizethat medicine is not one size fits
all.
Menopause can look verydifferent depending on who you are
and also how you're treated.
(03:39):
Studies have shown thatspecifically black women go through
menopause earlier, haveperimenopausal symptoms longer, and,
you know, they have a higherrisk of some of the long term, chronic
conditions than, you know,other groups.
So it really became veryimportant to me as a mission to be
(04:01):
able to bring thatconversation to all women.
A lot of doctors who may bedismissing these symptoms aren't
aware of the profounddifference when it comes to long
term and chronic healthbenefits that black women may experience
by starting hormone therapy orat least being educated about the
option during the earlierstage right before they've gotten
(04:23):
down to like full blown menopause.
And I'll tell you this oneother thing, Jackie, because I think
it's really important when itcomes to black women specifically,
because again, there is a lotof mistrust with the medical system.
Right?
So I had another patient who Istarted her on the patch and progesterone
testosterone, and she ended upgoing to her primary care physician
who basically told her, I amnot talking to you.
(04:45):
Her primary care physician was.
Was also African American.
I am not talking to you aboutthis because our ancestors didn't
use this stuff.
So I am not counseling you on it.
Thankfully, that patient cameback to me and said, okay, my doctor
started me on a blood pressure med.
Is it okay for me to continueon my hormone therapy with this blood
pressure med?
Because my doctor wouldn'ttell me that is a level of trust.
(05:05):
Because that's another reasonright there where she could have
been like, no, yeah, you're acomputer doctor.
I don't know you yet.
My primary doctor.
I see her in person.
So, you know, it's really.
You feel like you're making abig difference.
Speaking of computer doctors,virtual care is on the rise.
Telehealth companies focusedon midlife women's health are growing
fast because the demand forpersonalized, accessible menopause
(05:29):
care is bigger than ever.
And the best part is you canget it all from the comfort of your
home.
But is this kind of care onlyfor the wealthy, or is it truly accessible
to all?
I've had women across theboard, right?
The women who come and they'relike, you know what?
Give me everything, and, youknow, money is not an issue.
And then I have other womenwho come who are like, hey, I really
(05:52):
want to, you know, use my insurance.
I want to be able to figure it out.
But I think one thing that isso great about the Alloy platform,
and I hear this from a lot ofpatients, is that you're getting
a response from your clinicianabout any issue that you're having
within a short period of time, right?
It's not this situation whereyou put a message into your doctor
(06:13):
who's taking care of multipleother issues, right?
A lot of us are primarilyfocused on this stage in life, and
so, you know, we're able torespond within a reasonably short
amount of time.
Sometimes it can be a fewhours, sometimes it can be a little
longer, but we're respondingin real time to the concerns.
And I find that a lot ofpatients find so much value because
(06:34):
I've had patients on the Alloyplatform who said, I want to go take
this prescription to my doctorand prescribe it.
And we have just a policywhere we say, if you're going to
do that, you can definitely do that.
However, we want to make surethat you have access to this 247
doctor messaging, as well asbeing able to if there are any issues
(06:56):
with shortages.
We have been really successfulin being able to make sure that there
is no interruption, you know,for patients, you know, when shortages
in certain forms, like theestradiol patch, we have been very
fortunate in being able toassure patients that they will have
continuity.
The only thing is, we may notnecessarily be able to say that you'll
(07:17):
get the same manufacturer, butwe really make sure of that.
And then I think of otherplatforms that do take insurance.
I think it's just I've had somany patients say the fact that I
can be on my lunch break or inmy office when I take a break and
I can just kind of do all thisstuff, fill it out.
I get an answer.
When I'm on my way home, Inotice the doctors messaged me.
(07:38):
By the time I get home, I canmessage back, answer any questions,
and then, boom, it's deliveredto my door.
I think we have transitionedfrom a very simple system barrier,
right?
Like the system of medicinethat has a lot of barriers when it
comes to getting what we need,to a system where access.
(07:58):
Being able to talk to yourdoctor directly, being able to get
an answer from your doctor,being able to know that I can get
my prescriptions shipped to me.
If there's a mistake, I cantalk to the support team.
It's really a big team thatworks together, and everybody's taken
care of a specific aspect tomake it so that the experience for
the customer or the patient,we call the patient.
(08:21):
But obviously on the otherside, it's the customer experience
for my patients is taken care of.
Like, if there's any error,any issue, boom, I can reach out
to support.
They can get that message quickly.
They go to the pharmacy, andit's taken care of.
And I think that's what I loveabout being in a system like this
versus being in a structurewhere we're dealing with an insurance
(08:43):
company and, you know,preauthorization, this is not covered.
We bypass all of that.
And you can't get in for sixmonths if you make an appointment.
And I've had patients who comeand say that I couldn't get in for
six months.
I am dying.
Please at least get me inuntil I can see my doctor.
Yeah.
So it's providing a real service.
And there's some people whoare in remote areas.
(09:05):
Like, I have patients who arein remote areas, and they don't have
access to menopause trainedphysicians in some of those remote
areas.
So, you know, I have licenses,you know, in 20 different states.
So I get to see patients in 20different states.
And so I have a patient in Maine.
You know, I have a patient inArizona, and I know them, and I appreciate
that.
Even with this platform, thatability to connect and know my patients,
(09:29):
I mean, they'll send meselfies and like, Dr. Do, this is
how I look today.
I just wanted to, you know,because there's that desire to connect,
and they figure out how toconnect with us in some way.
Yeah, that's amazing.
All right, let's get into the basics.
These are the screenings andlabs every woman over 40 should know
about.
Don't worry.
I know it's a lot to keeptrack of.
So I've put together a simpleguide, kind of a cheat sheet with
(09:52):
everything we cover in this episode.
You'll find the link whereveryou're listening or watching.
So let's talk about just someof the general screenings that we
recommend for all women over 40.
So one of the things, I mean,the main thing we recommend, at least
the American College ofObstetrics and Gynecology, is a screening
mammogram.
Right.
And this just gives you yourbaseline risk for breast cancer or
(10:14):
any type of breast conditions.
And this is recommendedstarting at age 40, and we recommend
it every one to two years.
If you have no risk factors.
If you have risk factors, itmay look a little different.
And when I talk about riskfactors, it could involve, like,
family history.
It could be of, you know,breast cancer diagnosed at a young
(10:35):
age.
It could mean that you've had,you know, the BRCA gene or some other
gene, because there's, youknow, the check 22 mutation.
There are all these differentmutations that are there.
So, you know, it may mean thatyou get your mammogram earlier.
It may mean that you getadditional testing, like you get
an mri or you end up getting amammogram, you know, with ultrasound,
(10:57):
or you just maybe get morefrequent testing.
Right.
So it really depends on whatyour risk factors are.
If you have absolutely no riskfactors, you're really looking at
getting a mammogram every oneto two years, at the very least,
starting at age 40.
Okay.
Okay.
And that's one screening test.
Is there a time where you stopgetting mammograms?
So the number that has beenquoted is 75.
(11:19):
If you have any form of riskfactors, like if you are on hormone
therapy, like, I personallywill continue with my patients.
But it's obviously aconversation between the two of us
because there are somepatients who are just like, absolutely
not.
My role, my responsibility isto arm you with the guidelines, give
you the information, and I cangive a recommendation.
(11:40):
At the end of the day, it'sreally like the patient autonomy.
And then the next thing weknow of is the Pap smear.
And, you know, before the ageof 21, we typically don't recommend
a Pap smear being done.
But once you get to the age of21, that's when we start 21 to 29,
we look at doing a Pap smearwith an HPV every three years.
(12:02):
Okay.
Versus what we used to dobefore, which was every year.
And I think it's important toidentify that the combination of
the Pap.
And the HPV has increased thesensitivity of the test.
And that's why we've kind ofspaced out the time frame.
Because not only that, butalso when you're in that early age
group, 21 to 29, you're moreinclined, if you do have HP, to shut
(12:26):
it, like your immune system.
And your body is very strong.
And hpv, even if it does leadto some lesions, your body tends
to really shut it.
So that's why age 30 to 65.
Now we start recommending youcould do the HPV along with a Pap
smear.
And that's done every five years.
(12:47):
So it's important to realize that.
And this is where I think itbecomes a little tricky because patients
start to think, oh, I don'tneed to go to the doctor for five
years, which is not the case.
You know, it's not the case at all.
It's really important that youare going because, you know, when
you go for your annual exam,we're screening you as well for like,
are you having any irregular bleeding?
What are your periods like?
(13:07):
And are you having bleedingafter intercourse?
And sometimes some of theanswers to those questions may mean
that we need to do, you know,additional, you know, additional
screening or additional testing.
We also, it's important for usto do a pelvic exam so we can feel
your ovaries, feel youruterus, does it feel enlarged?
You know, and that helps alsoguide us and determine whether or
(13:28):
not we need to do additionalimaging, like an ultrasound, endometrial
biopsy.
There's just a lot ofdifferent things that we're looking
for.
And it's not just confined to,you know, your Pap smear.
Right.
And then is there an end whereyou stop getting a Pap?
You know, I mean, I guess ifyou don't have a cervix.
Right.
Like, that's.
Yeah.
(13:49):
So if you've had it.
If you.
Absolutely.
If you've had a hysterectomyand you have had no risk factors.
Right.
So your Paps have been fine.
Like, you've had no risk factors.
You do not need a Pap smear anymore.
If you are 65 and over andyou've had no risk factors, you definitely
can stop getting your Pap atthat age.
(14:10):
Okay, good to know.
And that those are just someof the, you know, the guidelines
that we go by.
And I think it's important tooto remember that these are population
based guidelines.
Right.
And, and I think it's reallyimportant, especially for women to
identify, like, if I'M feelinglike something's not right, you know,
and, you know, in my body, Istill tell my patients to bring it
(14:33):
up and ask, you know, if thatis something, because you know your
body better than we do.
And we're going based onpopulation numbers and not, you know,
individual, you know, people.
And then there's the dreaded colonoscopy.
Everybody talks about thatprep, but I promise you, it's not
that bad.
I've had a few.
(14:53):
But when should we expect toget our first?
So if you have no.
No risk factors, no familyhistory, we say age 45.
Okay.
And I think it's important torecognize because for a long time
it was age 50, and I thinkwith a lot more younger people being
diagnosed with corporations,colon cancer and later stage colon
(15:15):
cancer, and they looked at thestatistics and they changed the guidelines
and basically said 45 is whenit's recommended to start having
a colonoscopy.
I waited until 50 because Ijust, I. I did because I just, you
know, it's the mind.
It's like thinking about theprep, thinking about the whole procedure.
(15:35):
It just took me a little bit.
But I do tell my patients 45as know what the guidelines are.
And I think the beautifulthing about that is if it's normal,
it's every 10 years.
So, you know, unless they finda polyp, unless they find something
that may be concerning, it'sat least every 10 years.
And it's reassuring when youcan get a negative one because you're
(15:56):
like, okay, I've done that.
Like, if there changes in mybowel habits, which can occur during
the perimenopausal transitionand into menopause, your bowel habits
can change.
But I always say that it is soreassuring to be able to know that,
okay, I've had a colonoscopy,and I know that there is nothing
pathological going on.
Every individual is different.
Okay, you smoke, you may haveanother history.
(16:16):
Like, it may be worth having acolonoscopy done before age 45.
But I think you would reallyhave to tease out your individual
risk factors.
But definitely, if you alreadyhave chronic disease within your
GI tract, you are already acandidate or somebody who.
It is recommended to have acolonoscopy sooner.
That makes sense.
(16:37):
As a side note, it's importantto be honest.
They ask if you smoke, theyask if you drink, they ask, you know,
about sexual partners or whatever.
I can only imagine from yourside, people don't want to be judged
or perceived as something.
What would you say to thosepeople who are just.
They don't want to necessarilygive all the information.
(16:57):
This is something that comesup for me all the time, because as
an OB GYN, right.
STDs are one.
You know what your history is.
And sometimes it may beimportant that if there's somebody
else in the room, I just havethem step out.
And I think it's important.
The other area where I findthat people have a tendency to lie
is when it comes to justsubstance abuse.
And here's how I frame it.
(17:17):
When I ask the question, and Ijust said, you know, this is a question
I ask everybody, and I'masking so that I can actually be
able to help you.
And I want you to be able tofeel comfortable, to be able to be
honest with me.
So I think when you preface itlike that, because that it's a space
of no judgment.
It's really like clinicalinformation that will help me be
(17:38):
able to help.
Come up with the besttreatment plan for you.
They tend to be a lot morewilling to tell the truth, but it
takes years of doing this and,you know, knowing that there are
a lot of people who don't wantto admit to any substance abuse,
and if they do, they want toerr on the side of, like, even less
than, you know, what they maybe taking at the time.
(18:00):
If the patient feels thatthere will be no judgment, I think
it's easier for them to beable to open up.
Absolutely.
It's like when they ask aboutyour weight on your license.
Why.
Absolutely.
We all.
That's another area that isdefinitely another area that it can
become.
Because usually, like, when Iwas in the hospital, they get weighed,
(18:22):
or we have it in their clinic chart.
Right.
But it's definitely, you know,because we get records.
Right.
So they're weight at their offices.
So it's.
It's not anything that I'veever had to navigate until I was
doing telehealth.
And I have to ask.
And some patients refuse toput their weight on their intake
forms.
But I think when peopleunderstand the why, it makes it a
little bit more helpful forthem to be a little bit more open.
(18:45):
What are some of the reasonsthat you would want to know somebody's
weight?
So, I mean, this is a segmentinto heart health, which is beautiful
because one thing that it'snot stressed to us women is the number
one killer for women iscardiovascular disease.
And what I tell patients and Itell myself this is.
(19:08):
It's so important to know your numbers.
Right.
Because there are specificrisk factors for cardiovascular disease.
And when you know what yoursare, we can look at mitigating them.
And so either your bmi, which,that's another metric that's probably
going to be going away soonbecause we're going to be looking
at body composition.
But right now, what we have togo with overall is just a bmi, which
(19:29):
is really takes into accountyour height and your weight.
If you know that number, youknow where you kind of fall into,
if it's normal, if you'reunderweight, if you're overweight,
or if you're obese.
And that is a known riskfactor for cardiovascular disease.
But not just that in isolation.
Right?
So I tell patients it's notjust your bmi, but I'm also interested
(19:51):
in your hip waist circumference.
And what that is, is you takea tape measure, you measure the thinnest
part where your belly buttonis around, you know, your waist,
and then you go to the widestarea around your hips, and we look
at that ratio and that givesus a sense if it's above 0.8, it
tells us whether or not youhave a lot of visceral adipose fat
(20:12):
around your organs.
So if we know that you have alot of visceral fat around your organs,
especially your heart, that isanother risk factor for cardiovascular
disease.
Right?
So knowing what that numberis, knowing what your blood pressure
is, you know, I like, okay, itwas taken at the doctor's office.
I don't know, they told me itwas normal.
But knowing where you are inthe spectrum is important.
(20:35):
Even if you are normal and ifyou are borderline, knowing that
you're borderline, and even ifyou go to the doctor's office and
they tell you your number,asking, hey, where does that stand?
You know, where am I?
Am I in the good range?
Am I in a borderline rangewhere that's something to be concerned
about?
And obviously if you're in ahigh range, I'm thinking they would
(20:57):
tell you.
But I think it's important forus to know our numbers, right?
So it's think of your highblood pressure, you think of your
lipid panel.
What is your cholesterol value?
Right.
I think as a doctor, you know,I kind of would be like, oh, I have
a vague idea.
But, you know, I never reallytook this on as being in charge of
(21:18):
my cardiovascular health.
So it was just like, okay, youknow, what is my test result for
prediabetes?
Am I far away from that?
Am I close to it?
Am I pre diabetic or am I fullblown diabetes?
Right?
So we have a test called.
It's a diabetes screen.
It's a hemoglobin A1C.
So it tells you what yourblood sugars have been doing over
(21:40):
the last three months.
That is another key, importantmetric when we're looking at heart
health, because we know thatwhen you go through midlife and you
have this shift in hormones,you develop a level of insulin resistance
that's important to screen forbecause it's profoundly impacted
by when your hormone levels shift.
And then being able to know,like, your lifestyle, what is the
(22:02):
quality of your sleep, how areyou managing stress, what is your
nutrition like?
So when you ask thosequestions, it really gives you a
clearer picture of what yourparticular risk factors for cardiovascular
disease are.
And that should be like,something that we all know, because.
Right.
If that's the number onekiller of women, why wouldn't we.
(22:24):
Right.
And does that require going toa cardiologist?
Or we can get that as just ageneral well visit.
General well visit.
You can get that either atyour primary care doctor when you
go in for your gynecologistfor your annual exam.
We've covered the bigscreenings and heart health.
Now let's move into the restof the blood work that's important
(22:45):
to look at, starting with your thyroid.
A thyroid function panel.
Like, it's really important toget that done, because I think if
your thyroid levels are low,that can mask many different conditions.
And if we don't know that yourthyroid has been assessed and we
can get you back to feelingmore like yourself, that is a huge
(23:07):
part that could potentially be missed.
So, you know, your thyroid isresponsible if you're fatigued, if
you feel like havingdifficulty with temperature regulation,
hair loss.
These are all common symptomsthat can occur during midlife.
But again, thyroid can be oneaspect that's contributing, you know,
or it could be just yourovarian hormones.
But it's really important thatwe can eliminate that as a potential
(23:32):
cause for symptoms, by the way.
And it also may cause weight gain.
And these are really profound,bothersome symptoms that occur during
perimenopause and menopause.
Right.
Vitamin D level is another onethat's really important.
And I always say, like, abaseline blood count, which is what
we.
A cbc, which is just yourgeneral blood count that tells us
(23:53):
whether or not you're anemic.
Because, again, if you'rehaving symptoms of fatigue, it's
important for us to know oreven to get a baseline and then,
you know, a complete metabolicpanel which tests for your kidney
function, your liver function,Just to get a sense of what chemically
is going on in your body.
Are these organs functioning normally?
Are they sluggish?
(24:13):
Are we seeing things that wemay not have known, you know, like
your liver function?
They're elevated.
Then we can kind ofinvestigate and look at why.
Why is your liver functionsuboptimal at this point?
Have you been exposed tohepatitis B or hepatitis A or any
condition that could impactyour liver function?
Ferritin is another good testto do in midlife, and it tests our
(24:35):
ability to store iron.
And that's important becausehair loss, like, if you're iron stores
are low, it can contribute tohair loss.
And I think when we go throughthat transition, we're trying to
figure out what is causing myhair loss.
And also, like, is it my hormones?
Is it this?
Is it my thyroid?
Because thyroid can also cause that.
(24:56):
It's important to kind ofscreen for ferritin levels.
Your iron stores, do you haveadequate iron stores?
Because that'll also helpeliminate some symptoms that you're
having or how we can come upwith a treatment plan that applies
to you.
Right.
I could see how easy it couldbe to, like, brush off a lot of these
symptoms as just perimenopauseor menopausal symptoms, because it's
(25:16):
like, here you have yourcategory of menopause, and then here
you have your thyroid iron.
All of these over here, andthey mirror, they resemble each other.
And so I'm assuming it'sreally important to just not disregard
symptoms and just go and getit checked out.
Yes.
And this is why I tell allpatients, just get your screening
(25:37):
labs and make sure that we'velooked at all of these things and
know that we're not looking atany other deficiencies that could
be contributing to symptoms.
Because this is foundationalwhen it comes to being able to really
make a diagnosis.
Right, right.
Because we know perimenopauseis a clinical diagnosis.
And so we look at symptoms, welook at patterns.
(26:00):
So it's not like there's atest for us to do that'll be like,
oh, and this is why it's sohard, I think, for women sometimes
to be able to understand,wait, well, aren't you going to check
my hormones?
Because, like, if it.
If.
If like diabetes, this numbermeans this, this number means this,
this number means that.
And unfortunately, it's notthat simple.
So it requires just a littlebit more explanation so that patients
(26:25):
understand how we look ateverything together to be able to
determine what we do.
So there's another test whichI Recommend to patients, if you can
get the ones that I talkedabout foundationally, that's great.
But there's another testcalled lipoprotein A, so it's lp.
And the reason why I includethis, it's a one time test.
(26:45):
It's not something that youget done like every couple of years.
It's just done once in your life.
And what that is, it's agenetic, it tells us your genetic
risk for cardiovascular disease.
Do you have any intrinsicgenetic risk for developing cardiovascular
disease?
And so why that's of benefitis because you get to work very closely
(27:05):
with a cardiologist.
Right.
Or you get to work with maybeeven a PCP to make sure that your
numbers are dialed in, yourblood pressure, your cholesterol.
Like, we're not just beinglike, you're a little close here,
you're a little close there.
No, that really helps yourdoctor identify whether or not your
numbers need to be dialed in alittle bit more.
(27:27):
Like if your blood pressure isout there.
No, we need to have you comeback next week.
And if lifestyle changes,don't change it, we will need to
put you on something to helpmanage that because we cannot afford
for you with this elevatedlipoprotein A to have your numbers
kind of, you know, becauseyou're just a higher risk.
(27:48):
Yeah.
And so is that a test that alot of doctors are aware of, giving
and also is it covered byinsurance typically?
So that is a wonderfulquestion because I was not aware
of it until a couple years ago.
And so I think this is the thing.
As we really look at theoverlap from cardiologists, from
(28:10):
knowing the joint, like themusculoskeletal syndrome of menopause,
as we learn how to reallyimprove and impact women's health,
my colleagues who are OBGYNsand who aren't specializing in midlife,
they don't know because we'renot taught.
We're not taught.
Unless you are in rooms withprimary doctors, like right now,
(28:32):
the space for taking care of women.
Like, they're orthopedicsurgeons who've carved out a niche,
they're PCPs, they're family doctors.
So when we come together witha confluence of all this information,
they're cardiologists, weelevate and we educate each other
and elevate so that peoplelike me who want to do best for patients
(28:54):
are able to know that, ah,that's something that I need to look
at, educate my patients and,you know, move it forward.
My OBGYNs at the hospital whoare doing Deliveries.
I'm not going to say all ofthem, but very few of the ones that
I worked with are aware of it.
Wow.
Yeah, that's wild.
And this is just according tothe American College of Obstetrics
and Gynecologists, if you'venever had these two tests ever done
(29:17):
before, it really is importantto have them done at least once in
your lifetime.
An HIV and a hepatitis D. Soif you've never had these done in
your lifetime, it's consideredat least once in your lifetime to
be screened for that.
These are some things, youknow, if you are getting screening
labs from your pcp, your OBGYN can order these labs.
And they're very basic, like,this is the low hanging fruit.
(29:40):
This isn't anythingcomplicated, anything beyond this,
because there's so many other tests.
Right.
But I'm just talking at like,what is it that is the foundational,
the easy things to look at,because I think sometimes it's very
easy to be overwhelmed with alot of information that's out there.
And then we start to wonder,okay, well, do I need this?
(30:01):
Do I need this?
Do I need this?
I'm just trying to keep it simple.
Screenings, heart health,blood work, check.
But there is another area thatoften gets overlooked.
Our bones.
Let's talk about the bones.
Because I have had countlessconversations with women, just in
my experience, the mostignored, like most of the women that
(30:24):
I talk to.
And I've said, have you everhad a scan?
They're like, no, never.
Is it just because I'vepostmenopausal for so long?
Or should we all be gettingthese bone scans?
So here's what the guidelinessay, and I'm going to put that caveat
there because we're in an erawhere the guidelines no longer reflect
(30:46):
all the information that hasbeen gathered, all that we know so
far for women who are inperimenopause and menopause.
So the guidelines essentiallyindicate that a DEXA scan is indicated
at age 65.
Okay.
And if you think about it, byage 65, I think we can make a lot
of change occur before then.
(31:06):
If we knew, right?
If we knew our bones werethinning, if we knew that we had
osteopenia by age 65.
I think we're now looking ateither pharmaceuticals or some women
may not want to start estrogentherapy that late, you know, considering
it's outside the window.
But so I think we are in aspace where the guidelines have not
(31:29):
caught up with what we knowabout what the changes that occur
in women's bodies.
Right.
The only way that you can getan insurance to cover a bone scan
before age 65.
Two reasons.
If you personally have hadmenopause before age 45.
Right.
If you have had surgicalmenopause or premature ovarian failure
(31:50):
or something, or earlymenopause Prior to age 45, you are
definitely a candidate for aDEXA scan.
Or if you had a family historyof osteoporosis.
And I know the temptationwould be, okay, well, I'm just going
to say that I have a familyhistory of osteoporosis so that I
can get it approved.
And yet, you know what?
We shouldn't have to do that.
I mean, I think what I tell mypatients these days, it's either.
(32:15):
There are usually great out ofpocket contracted rates for people
to get a bone density scanthat may not necessarily be covered
by insurance.
But I recommend at leastgetting a baseline or even one where
once you are at that point ofmenopause, like you've gone through
the 12 months, I mean, even inperimenopause, getting at least a
(32:38):
baseline so you know where you are.
Right.
Because I think when we'reinformed, when we know what's going
on in our bodies, we're moreinclined to make the changes necessary
than.
And like with the resistance training.
Right.
Okay.
I know my why.
My why is because of my bones.
I want to be able to reduce myrisk of a fracture.
I find that women tend to bemore powerful when they are very
(32:58):
clear on their why.
So I think there is no costthat I would put when it comes to
my health and being able tounderstand what's going in my body.
However, I think one of thethings that we are advocating and
fighting for is for thatguideline to be changed.
Absolutely.
(33:18):
And if you can't get itcovered by insurance, really being
able to look at what programsare available to be able to get a
DEXA either at the least costpossible, or talk to your insurance
rep to see if there's a waythat your insurance would be willing
to do it.
But I think again, I don'tRecommend waiting until 65 for my
patients.
I tell them to get it done sooner.
(33:39):
Yeah, yeah.
So I'm not a doctor, so I'mnot held to the same standard you
are.
Um, so I just lie if I feellike I need to have something checked.
And I like, I trust my gut, myspidey sense.
I recently got a Covid boosterand I don't have any of those, you
(34:02):
know, under 65.
Listen, if there were a shortage.
Yeah, I would not do thatbecause I don't want to take medicine
away from somebody.
Like, that's.
That's not what I'm looking to do.
But that's not the case.
We just have some people incharge who think that they know best.
I also have, you know, familymembers who have very delicate situations
and they live in my house.
(34:22):
And so, yeah, if I can preventgiving them something.
So anyway, so listen, that.
That's why I do.
I go, wink, wink, wink.
Family history.
Osteoporosis is a reason toget it covered.
Yeah.
And I don't think they'resending out a detective to determine
whether or not that issomething that's true.
(34:43):
Wink, wink.
We'll just go with that.
When it comes to protectingour bones, there's a simple daily
step that can make a big difference.
And it might not be what youthink it is.
So I think I want to mentionone specifically relating to just
our conversation about bone health.
It's really like getting avitamin D level because I think it's
really important.
(35:03):
We all think about calcium.
Calcium.
Calcium in our bones.
Right.
But I think it's important toremember that vitamin D, it's responsible
for helping that calciuminterchange with your bones.
And so I always make sure thatI identify what your vitamin D level
is because it's very importantto know, hey, are you deficient?
And if you are, it isimportant to supplement because we
(35:26):
want to maximize on your bone health.
Right.
So it's going to be theresistance, exercise, training, having
protein in your diet, but alsovitamin D. So that's just to complete
that bone health.
I walked away from thisconversation with a checklist and
a whole new level of clarity,but it's a lot of information.
So to make it easier for youto take charge of your healthcare,
I've created a simple healthcheat sheet with all the screenings
(35:48):
and labs we covered today, aswell as info on hormones, supplements,
and vaccines that we'll coverlater on in the series.
I'll provide the link whereveryou're watching or listening.
And remember, this is just thefirst in the series with Dr. Dambo.
You don't want to miss what'scoming next.
So hit subscribe and turn on notifications.
If this episode was helpful,please share it with a friend because
(36:11):
every grown ass woman deservesto feel informed, empowered, and
supported.
Until next time.
You are a grown ass woman.
Act accordingly.
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