October 8, 2025 • 57 mins
Are you tired of feeling like you're navigating menopause or perimenopause alone, armed only with contradictory advice and sensationalized headlines? Dr. Holly Thacker, Director of the Center for Specialized Women's Health at Cleveland Clinic, is here to change that.
In honor of October being World Menopause Month, we are replaying this first episode of Dr. Thacker's podcast series based on her book, "The Cleveland Clinic Guide to Menopause."
In Chapter 1, Choosing and Seeing a Doctor at Midlife, Dr. Thacker addresses a fundamental truth often overlooked in women's healthcare: there are no one-size-fits-all solutions. What works perfectly for your neighbor might be completely wrong for you. This personalized approach extends to finding the right healthcare clinician who understands that women's health concerns are rarely black and white. She offers practical guidance on identifying red flags in healthcare interactions and selecting a physician who specializes in midlife women's health.
Ready to reclaim control of your midlife health journey? Join Dr. Thacker throughout World Menopause Month as she continues this series with more episodes on menopause. Remember—it's your body, your hormones, and your choices.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Holly L. Thacker, MD (00:10):
Welcome.
This is a special edition ofthe Speaking of Women's Health
podcast.
I am your host, dr HollyThacker, and I'm also the author
of the book the ClevelandClinic Guide to Menopause
Everything you Need to Know toThrive During Menopause.
(00:32):
So I'm beginning the first of apodcast series of this book.
This book was published andI'll be updating it along the
the way by Kaplan Publishing inNew York.
Some of the reviews I'll read toget you interested and I'll be
(00:52):
doing one chapter at a time soyou can listen to the whole book
or just, based on the titles ofthe chapters, you know, listen
to the ones that you'reinterested in.
So this was from Dr ElizabethHB Mandel, who is an associate
professor of the Department ofOBGYN at the University of
Virginia and she was on theNorth American Menopause
(01:15):
Consumer Education Committee.
Her quote about this book ismidlife women who are feeling
betrayed by the unpredictabilityof their bodies and overwhelmed
by conflicting claims of themedia will find clarity and
empowerment in the pages of thisbook.
Dr Thacker demystifiesmenopause by using simple
(01:37):
language to explain how thedecline of estrogen levels can
manifest itself as a broad arrayof symptoms, and she offers
practical strategies for copingwith these symptoms.
The author acknowledges thateach woman's approach to
menopause with a unique set ofchallenges genetic risk,
surgical history, medicalhistory, family stressors and
(01:57):
she invites the reader toexplore different options for
meeting these challenges.
This is an empowering messagefor all ages.
The next review is by SylviaMorrison, a marketing executive.
Dr Thacker is thequintessential physician
advocate for women and ourhealth.
Her advice is sound, thoroughand easy to follow.
(02:18):
Dr Thacker empowers you to makegood choices at so many levels.
And then finally, dr WendyKlein, associate Professor of
Medicine, obgyn at the VirginiaCommonwealth University School
of Medicine, and was a DeputyEditor of the Journal of Women's
Health states quote theCleveland Clinic Guide to
Menopause is rich with practical, scientifically grounded advice
(02:42):
for healthy living.
It's filled with soundstrategies for dealing with the
challenges of aging gracefully.
This is a must-read book thatwill help empower women during
midlife.
Okay, so let's begin theCleveland Clinic Guide to
Menopause and I dedicated thisbook.
(03:02):
It's my pleasure to dedicatethis book to you, the reader,
and now the listener, and tothousands of women I've had the
privilege of treating during myyears of practice in
interdisciplinary women's health.
I am so glad to beginpodcasting this book.
My middle son, emerson, told mefour or five years ago that I
(03:25):
needed to get right involved inpodcasting and I knew that I
should.
But I'm so glad to be gettingaround to doing it.
And part of the reason why wedecided to start to podcast at
Speaking of Women's Health, ournonprofit, which you can visit
at speakingofwomenshealthcom, isbecause we did have a medical
(03:46):
grant from Estellas and Bayer tohelp educate physicians and
nurses and pharmacists aboutvasomotor hot flashes in women
and some exciting research andsome potential upcoming options
and products that we'reexpecting on the market in 2023.
So I have done three types ofpodcasting.
(04:09):
One is for laywomen.
That includes a lot of greatinformation that we have on our
website, which has social mediaand free treatment guidebooks
and breaking health news andrecipes.
So please visitspeakinginwomenshealthcom news
and recipes.
So please visitspeakingofwomenshealthcom, the
Medical CME podcast, which isfor free medical credit for
(04:37):
physicians, advanced practiceproviders and other folks in the
healthcare arena.
Many of our women listenersalso enjoy listening to those
interviews of prominentphysician experts.
So the third series ispodcasting this book and it was
published in 2009.
It's now February of 2023.
(04:58):
And instead of writing a thirdbook, because this is actually
my second book, instead ofwriting a third book, because
this is actually my second book.
I've worked on the websiteregularly and updated that
almost on a daily basis, and sothat's why I never really felt
the need to write a book.
And even though this book waspublished in 2009, and there's
been a lot of scientificadvances, new treatment options,
(05:20):
most of all, the basicinformation about perimenopause,
menopause, hormonal therapyissues that affect women at
midlife really are prettysimilar, and the nice thing
about podcasting is I can justupdate this as we go.
So I'm going to start with theintroduction and chapter one,
(05:41):
which is choosing and seeing adoctor at midlife.
So my introduction is so you'rea woman facing midlife and you
care about your health.
So you read the headlines andyou tune into news programs, and
if you miss the story of theday, you can count on a friend
to fill you in.
(06:01):
Or perhaps you get a news feedcontinuously on your cell phone.
Get a news feed continuously onyour cell phone.
So daily so-called cutting-edgereports that spout the latest
findings on women's healthbreakthrough medications,
warnings about therapy, newweight loss fads, breast cancer
rates they just seem to betalking to you.
So midlife can be a good timeto take stock of your health and
(06:25):
feel invigorated and plan foryour second adulthood.
For many women, it's just amarvelous time, but other women
spend midlife barely stayingafloat, frantically, dog
paddling in a sea of turbulentsymptoms that affects their work
, their health, their sleep,mood, sex life and happiness.
And if that wasn't enough, theyalso have to deal with a
(06:47):
barrage of mixed messages.
You might hear that newresearch indicates new low-fat
diets won't prevent heartdisease.
Or maybe you hear that avoidingall carbs will not help you
lose weight.
Or that all hormone therapy isdangerous.
That's not true.
Or those vitamins you're takingare worse.
One day your prescription's amedical miracle, the next day
(07:09):
it's a killer.
Talk about frustrating.
If this were true, or evenpartly accurate, being a woman
today would be quite the riskybusiness, but this should be the
best time in history to be amidlife woman, thanks to the
availability of so many safe andeffective options for staying
in great health.
Instead, though, I see drovesof women suffering because of
(07:32):
alarmist reports that havescared them away from proven,
safe, effective therapies, andthey're receiving erroneous
information and not as muchsupport from their health care
clinicians as they would like.
I see women weeping fromfatigue after they've gone off
hormone therapy becausesheet-soaking nighttime hot
flashes have robbed them ofsleep and left them exhausted.
(07:56):
I see depressed women broughtin by their husbands because the
sex drives vanished or thatthey're enduring random panic
attacks that make them feel likethey've lost control over their
lives.
I've seen women who've stoppedeffective osteoporosis therapies
because they're petrified theirjaw is going to drop off.
But in my then it was 20 years.
(08:18):
Now it's 30 years of practicingmedicine with a focus on
midlife women's health andmenopausal hormone therapy.
I haven't seen things as bad asthey've been post-women's
health initiative and thatreport was released in 2002, and
I just did a podcast about the20th year anniversary.
(08:39):
So my daily contact with womenand doctors and students in
training have shown me that toomany people, both in and out of
the medical field, have receivedmixed messages about women's
health.
But in spite of this, thespecialty field of women's
health and collaborative healthcare has really come alive.
(09:01):
I established our Center forSpecialized Women's Health at
the Cleveland Clinic in April of2002.
That was just three monthsbefore the headlines were
exploding with the exaggeratedreports of the so-called dangers
of hormone therapy.
When we opened the center, Ilaunched a for her telephone
(09:23):
hotline 216-444-4HER, which is4437, which women could call
with questions, concerns, makeappointments and have several
options.
(09:45):
And health, whether it'sholistic health, menopausal
health, bone health.
Many people are still deprivedof really crucial information
that could mediate theirneedless suffering and correct
the distorted media claims andimprecise research surrounding
women's midlife health issues.
So this book provides thatmissing information.
In the following chapters,we're going to focus on vitality
, health maintenance, hormones,hormone therapy, sleeping
(10:09):
problems, cancer prevention,bone health, depression, panic
attacks, heart health, sexualhealth and the truth about
vitamins and supplements, aswell as talk about some cutting
edge therapies for women'smidlife concerns.
So if you've picked up thisbook or you're listening to this
podcast, chances are you'llrecognize the struggles that
(10:30):
some of my patients share asthey cope with midlife.
I hope that I can help dispeldistorted media claims and
inaccurate interpretations ofresearch that misled and confuse
women and their doctors.
Most of all, I hope readingthis book or listening to this
book will give you peace of mindand offer sound, practical
(10:51):
information to help you regaincontrol of your health during
midlife.
After all, it's your body, yourhormones and your choices.
By the way, that was the titleof my first book.
So by listening to this book,you're taking the initiative for
better health and renewedvitality.
So congratulations, you are onyour way Getting answers.
(11:17):
Each stage of life brings newchanges and gives rise to new
questions.
We need answers that will helpmake our transitions smoother
and guide us into maintaining agood quality of life.
Unfortunately, we are manytimes misled.
The headlines don't spell outthe whole story and even
in-depth reports can leave outcritical research conclusions or
(11:40):
just jump to a conclusion tocreate media hype.
We've certainly seen a lot ofthat in the last few years
during this COVID pandemic.
The existence of so manyvariables can affect whether the
results of the research studyeven apply to you, and like I've
always said to my residents,fellows and medical students, is
(12:04):
that one study is just a pieceof the puzzle.
It's not the whole entirepicture, and you need a lot of
pieces of the puzzle before youcan see the big, bigger picture,
much less complete it.
So there's no doubt thatsometimes the media can be
helpful.
News programs, magazines,internet websites make us
(12:24):
realize how much information isout there and how many people
are committed to finding answersthat women can live the
healthiest, happiest and longestlives possible.
Many findings are inspiring andmore research is always on the
way, but the truth remains.
Most women are confused, andwho can blame them?
(12:45):
What's the real story?
Whom can you trust to give youanswers when those answers are
constantly changing?
Within the pages, you will findinformation on the following
Controlling menopausal symptoms.
The truth about vitamins andsupplements.
Diet and exercise to boostenergy.
Bone health basics.
(13:06):
Myths and facts about hormonetherapy.
Helping your heart in midlife.
Preventing cancer and otherdiseases.
Recharging your sex life.
Improving your vitality,longevity and quality of life.
Women's health specialists likemyself and others at the
Cleveland Clinic Center forSpecialized Women's Health have
(13:27):
dedicated our career to studying, researching and treating
women's health issues With sotight a focus.
Such doctors are better able tosee that big picture because we
have more of the puzzle pieces,and the Cleveland Clinic guides
are designed to help you fitall these pieces of the puzzle
together for your life.
We are all women, but we areall different, and you don't
(13:51):
need a physician to tell youthat we're all different.
Just look at your mother andsisters and girlfriends and
colleagues.
It should come as no surprisethat there's no one-size-fit-all
prescription that will calmraging hormones or restore
balance during a time of lifewhen change is the only constant
.
It is a fundamental truth inwomen's health that there isn't
(14:13):
a simple yes or no answer forevery question, including is
hormone therapy a solution forevery woman?
Can you tell whether or notyou'll get a difficult menopause
or perimenopause?
Tell whether or not you'll geta difficult menopause or
perimenopause?
Should you keep taking birthcontrol in early menopause?
Are antidepressants a good idea?
How can you stop hot flashesand get a good night's sleep?
(14:34):
Are there hysterectomyalternatives?
Can I get my sex drive back theway it was?
Is surgery the best answer fora leaky bladder?
The media likes to categorizeeverything as just good or bad,
but with women's health thisisn't just quite simple and
possible.
The only rules that apply toeveryone is don't smoke and wear
(14:56):
your seatbelts, and that'sabout it.
Even with diet and exercise,vitamin supplements, health
recommendations vary from personto person.
We all need a little somethingdifferent to look and feel our
best.
Using information gatheredduring the physical exam routine
test that can range from bloodpressure readings to mammogram
(15:18):
to bone density is like playinga card game Everyone gets a
different hand becauseeveryone's issues combine
differently.
The key is to develop astrategy based on the cards
you're dealt.
That's why it's critical tofind a physician experienced in
treating these midlife women'shealth issues.
It's also important to know theinformation you should have
about your own health and whatquestions you should ask.
(15:40):
What treatments are available,both medical and holistic, that
will enable you to maintain avital lifestyle.
You need to build yourknowledge.
Invest in yourself by gettingthe straight facts about you,
not your friend, not yourneighbor or mother or colleague
A strange disconnect.
When women come to see me thefirst time, they're usually
(16:03):
eager to request the mostcomplex, recently touted medical
test, but sometimes they don'tseem to know the basics of
everyday preventive health andthere's sometimes a disconnect
between what women really needand what they ask for.
For example, I have women thatask for that CA-125 blood test
(16:24):
that monitors for ovarian cancer.
This may be a helpful tool inevaluating how a woman is
responding to cancer treatment,but it's not a good screening
test for ovarian cancer becauseit yields a high rate of false
positives and it also can missearly cases of ovarian cancer.
And sadly I've seen manyotherwise healthy women who had
(16:44):
their healthy ovaries removedbecause that CA-125 test was
elevated, not because of cancerbut because of common,
relatively benign conditionslike fibroids or endometriosis.
And it baffles me when the samepatient who asked for
non-diagnostic ovarian cancertesting doesn't even know the
symptoms of the disease whichshe could be looking for.
(17:07):
Though subtle, there are signsyou can watch for Pelvic pain,
discomfort, pressure, changes inbowel movements such as
frequency and consistency,changes in urination or sudden
urgent need to urinate, painduring sexual intercourse,
abdominal pain, swelling or afull or bloated feeling,
persistent fatigue, weight gainaround the abdomen, along with
(17:29):
either sudden weight gain orsudden weight loss.
Many women don't know how tolisten to their bodies.
We haven't been trained in thisrelatively simple yet important
art.
In addition, we haven't beengiven reliable information.
For example, did you know thatusing the hormonal oral
contraceptive pill for fiveyears can dramatically reduce
(17:53):
your risk of getting diagnosedwith ovarian cancer?
Or that pregnancy andbreastfeeding also reduce this
risk?
Do you know it's been estimatedthat several cancer disease
risks could be reduced by 70% ormore simply by optimizing your
vitamin D levels?
This is not to say that allwomen should take the birth
(18:14):
control pill or get pregnant ordose themselves without
supervision.
On vitamin D.
Remember there are no absolutesin women's health, vitamin D.
Remember there are no absolutesin women's health.
Many educated women, even somewho are physicians, are not even
aware of cancers and otherdiseases in which they have
influence over.
The point is that, while manypatients ask for tests they've
(18:35):
heard about on the internet,like CA-125, that are not
usually helpful, many times theyneglect crucial basic
guidelines for good health.
This book will give you theinformation you need to do
everything that you can toensure your own good health and
vitality, and then you'll be inthe best position to make use of
the screening test and thetherapeutic treatments that your
(18:58):
doctor and you believe willhelp you live a long life.
It's all about the choices.
They say that knowledge ispower, but I'd like to make the
case that the right knowledge ispower.
When we understand our options,we can make better choices.
We can gain control over ourhealth, feel good about
(19:25):
ourselves as our bodies changeand mature, and enjoy our
relationships with friends andfamily more fully.
My goal is to share with youwhat we really know about
menopausal process, to dispelmyths about treatments like
hormone therapy, and to discussthe many ways you can maintain
(19:45):
good health and improve areas ofconcern.
Midlife is the beginning of atime when most women can focus
on their passions.
You've spent years raisingchildren or caring for a spouse
or family member, or maintaininga career, being a best friend,
sister and active communitymember.
Now it's time to take care ofyou, and I am your host, dr
(20:12):
Holly Thacker.
I'm the director of our Centerfor Specialized Women's Health
at the OBGYN and Women's HealthInstitute at the Cleveland
Clinic, and I am a professor ofboth medicine and OBGYN and
reproductive biology, and I amthe executive director of
Speaking of Women's Health, ourwebsite
speakingofwomenshealthcom, and Iam the fellowship director for
(20:37):
our specialized women's healthfellowship.
So moving on to chapter one.
It so moving on to chapter onechoosing and seeing a doctor at
midlife.
So, women, we are just naturalswhen it comes to sharing.
When we listen, we really hear,and when we talk, we express
our deepest worries and greatestjoys and form real connections
(20:58):
with our best friends, oursisters, mothers, co-workers and
neighbors.
Our male counterparts mightcall these verbal exchanges
chatter, but we women knowbetter and because we're so
practiced in reaching out anddiscussing personal issues, of
course we're able to find theright support we need when we're
worried about our health, right?
Well, not exactly so.
(21:20):
Does this case scenario soundfamiliar?
This is Ellen.
I haven't slept an entire nightin ages because these hot
flashes and night sweats.
If this keeps up, I don't knowhow I'm going to manage to keep
my job.
And with my daughter's weddingcoming up in three months, not
to mention my mother's kneereplacement, I'm not sure
there's going to be enough of meto go around.
(21:40):
I wonder if hormone therapywould help.
So I decided to ask my nextdoor neighbor.
After all, she's already beenthrough this.
Well, judy said she never tookhormones during menopause, since
their safety seemedquestionable.
And she doesn't seem any worsefor the wear.
She seems happy and healthy andthe way she and her husband
behave.
You think they werehoneymooning Now in my bedroom.
(22:02):
On the other hand, yes,emotional support is just what
women need.
In fact, there's research toshow that women with strong
friendships and support systemsrecover from illness better than
women who are more isolated.
You simply cannot put a pricetag on the value of human
connection and empathy.
(22:23):
Hearing and affirming me too,from a best friend might be just
the thing that pulls you out ofa funk, but that's not all you
need.
The right answers for yourneighbor may not be the right
answers for you.
Judy never took hormones andyet she enjoys a great sex life
(22:43):
Nonetheless, hormones mayalleviate your menopausal
symptoms, as they did for Ellen,allowing her to fully
participate in her daughter'swedding preparations, support
her mother after majororthopedic surgery, sleep better
and therefore perform better atwork and, just as important,
ignite some of that missing mojoin the bedroom.
So go ahead and talk withfriends and family, get
(23:04):
emotional support that you need,but when you're seeking medical
advice, don't leave your doctorout of the picture.
After all, mother, even yourmother, doesn't always know best
.
But where can you find a doctoryou can trust, one who's
knowledgeable about the ins andouts of women's health at
midlife?
I wrote this book in large partbecause I was so dismayed that
(23:26):
smart women were seeingotherwise good doctors who gave
them inaccurate informationabout all their women's health
options.
I cannot stress strongly enoughthe fact that women are
different.
We have different needs fromthose of men, children and even
one another, and during the timefrom peri to post-menopause,
(23:47):
starting at around age 40, fromperi to postmenopause, starting
at around age 40, we may need aphysician specialist who can
address the concerns unique tous.
Question is my OBGYN enough?
Many women obtain all or mostof their women's specific health
care from their OBGYN.
It seems to make sense on thesurface.
After all, obgyns specialize inwomen's health, don't they?
(24:09):
But depending on the nature oftheir medical practice, primary
care doctors and OBGYNphysicians may or may not focus
specifically on the healthconcerns of midlife women.
Some women's health specialists, such as North American
Menopause Society, credentialedspecialists, may have some
knowledge, experience orresources that you need, and you
(24:30):
can certainly go onmenopauseorg and then put in
your zip code and find a list ofpractitioners who have at least
taken a basic test on menopauseand shown interest in this
field.
So whom should you trust withyour health?
Well, it all depends.
Should I see a specialist?
(24:51):
If you have significant peri orpostmenopausal symptoms, such as
panic attacks, hot flashes,sexual dysfunction, problems
that disrupt your life orserious health disorders like
osteoporosis, you may want toconsider making an appointment
with a physician whospecifically concentrates on
women's health during midlife.
His or her practice shouldencompass a knowledge of
(25:14):
menopausal and hormone therapy,bioidentical and otherwise bone
health, osteoporosis evaluation,sexual health, gynecologic
services available on site, suchas pelvic exams and pap smears,
urinary incontinenceevaluations, mammograms and
breast health, breast healthrisk assessment, as well as
(25:35):
holistic expertise and optionsin nutrition, exercise and mood
disorders.
Because menopause is a normallife stage.
Some women imagine that theymust be weak if they need extra
help, but this isn't furtherfrom the truth.
After all, pregnancy anddelivery are natural life stages
and most women seekprofessional support, education
(25:58):
and sometimes even medicalintervention during these stages
.
So it's especially important tosee a women's health specialist
if you have a personal orfamily history of breast or
ovarian cancer, you'veexperienced blood clots, you've
had previous adverse reactionsto medications, you have a
personal or family history ofhormonal upheaval, or you've
(26:18):
been told that you need ahysterectomy and have no other
options that are presented.
Strong women take control oftheir health, and that means
seeking specialists who canprovide the support and
treatment options needed.
And just because someone saysthey specialize in women's
health or hormone therapydoesn't mean they actually have
the credentials.
(26:38):
And there are, unfortunately,shady people in the field that
have seized on the opportunityto profit from women's misery
and confusion opportunity toprofit from women's misery and
confusion.
So be wary of any of theseso-called professionals who sell
you supplements, concoctionsand so-called individualized,
compounded hormones that theydirectly profit from, all the
(27:02):
while claiming falselyreassuring you that their
personalized therapies aretotally risk-free and totally
natural.
When something sounds too goodto be true.
It usually is.
So what can I expect from agood physician?
Many women hit their emotionaland physical peaks at midlife
(27:23):
and they breeze throughmenopause.
Some make such a seamlesstransition they don't even
realize that they have gone intomenopause.
But most of these women I seeare not quite this lucky.
Their lives have been thrownoff balance as they enter
midlife.
Take Cheryl Well, cheryl'shusband of 23 years brought her
in for an appointment.
(27:44):
He didn't know what else hecould do to support his wife.
She was quote falling apart.
You'd never know it from just acasual glance.
Her appearance was flawless,she was dressed in elegant
pantsuit and she looked quitehealthy, but her eyes told a
different story.
Once in my office she describedthe symptoms she was
experiencing, and they turnedout to be worse than what most
(28:04):
women experience.
Escalating mood swings abruptlynoseosedived into emotional
crashes, making her feel out ofcontrol.
Her hot flashes were so suddenand substantial that she would
find herself completely soakedin sweat, having to change her
bedsheets.
Her sex life was sufferingtremendously because her vagina
had virtually shriveled up, andthis was particularly upsetting
(28:27):
to her because she and herhusband shared a deep love and
had previously had an enjoyablesex life.
As she was telling me all ofthis, she broke down and sobbed.
It turned out that Cheryl'sprevious doctor had prescribed
hormone therapy to restorehormonal balance and control her
symptoms, and the treatmentworked well.
But the doctors later pulledher off the drugs in response to
(28:49):
those controversial reports inthe medical and lay press that
so-called infamous women'shealth initiative.
For Cheryl, stopping thetreatments was the worst choice
possible.
So red flags, be wary if yourhealth care clinician imparts
absolutes.
Women's health issues are neverblack and white.
(29:11):
Answers to critical questionssuch as the following depend on
the individual when should I geta mammogram?
What kind of breast imaging isbest for me?
Is hormone therapy the onlyanswer to treating menopausal
symptoms?
Is my depression due tomenopause?
These questions do not alwayshave simple yes or no answers.
Every woman needsindividualized options,
(29:33):
education and support.
So if your doctor gives you asimplistic answer, move on.
You deserve better.
Granted, cheryl's case issomewhat extreme.
The severity of her complaintsare uncommon, but to one degree
or another, many womenexperience similar symptoms.
So no matter what physician youchoose, she or he should be
(29:55):
thorough and caring indiscussing and exploring your
symptoms, whether these symptomsare serious or more moderate.
During an initial appointmentwith a woman at midlife, I ask a
lot of questions.
This allows the patient toframe and express her concerns
and difficulties.
I tend to ask questions inlayers, first touching on the
(30:18):
health history and thenprogressing specifically to
menopausal symptoms.
If these symptoms seemespecially disruptive, I dig
even deeper.
From these questions and anexam I can generally spot
indications if a woman issuffering unnecessarily.
So I ask about what was the ageof your first menstrual period?
When did you give birth to yourfirst child?
(30:40):
If you had a child, did youbreastfeed?
If you had a child, have youhad any breast biopsies?
What are the results?
Do you have a family history ofany breast or ovarian cancers
or are there any cancersyndromes in the family?
When did you have your lastthin prep pap with HPV human
papilloma virus testing?
What's your cholesterol ratios,fasting blood sugar?
(31:02):
Have you had a mammogram or anykind of colon cancer screening?
Have you had a bone density,had a colon cancer screening?
Have you had a bone density?
If you're menopausal, what isyour history?
When did your period stop?
And if you had an ablation oryou have a Mirena intrauterine
system, did you get yearlyhormone checks to find out when
you went into menopause.
(31:23):
Have you had any abnormalbleeding?
What conventional or alternativetreatments, such as vitamins,
herbs and supplements, are youtaking?
What are your sleep patternslike?
Do you have trouble fallingasleep or staying asleep when
you wake up, do you fall asleepquickly?
Do you have any troublebreathing or snoring loudly?
Do you notice any shortness ofbreath during the day?
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Do you have any heartpalpitations?
Do you experience hot flashesor flushing?
Is the vaginal genital area dryor irritated?
Have you noticed any changes inyour skin, nails, hair?
What about changes in bowelmovement or bladder function?
How's your sex life?
What's your mood and energylike on most days?
(32:08):
Have you lost pleasure inactivities you previously
enjoyed?
Do you feel anxious ordepressed?
Do you notice if your anxietyor depression changes in
relationship to your menstrualcycle?
Do you have a personal orfamily history of fibroids or
hormone problems?
Have you ever experiencedpostpartum depression or severe
(32:29):
premenstrual syndrome, pms?
Ever have a history of anybipolar disorder or mania?
A patient's answers to thesequestions help separate some
classic menopausal symptoms frommedical conditions, psychiatric
problems or lifestyle issues,such as being under stress, from
raising teenagers and caringfor aging parents or having
excessive pressure at work.
(32:50):
And it can be challenging totease out what symptoms are
hormone-related from thosecaused by mental health or
environmental stressors.
An exam and questions such asthese are an excellent start.
Routine tests and screenings.
When caring for a woman inmidlife, a physician should
perform some tests andscreenings.
When caring for a woman inmidlife, a physician should
perform some tests andscreenings.
If you've chosen a newphysician, getting what is
(33:15):
called baseline scores on thesetests may help your physician
establish what's normal for you.
Knowing what scores you haveallows the physician or nurse
practitioner to trackimprovements or declines over
the months or years in betweenyour visits.
We do have an appendix onpreventive health practices and
other tips for midlife women.
(33:36):
So what are some of the testsyou might want to consider?
A mammogram it's a screen forbreast cancer.
A diagnostic mammogram isordered if you or your physician
identify a specific change orabnormality in the breast,
because it may involve spotviews or magnification views and
it may include ultrasound orthree dimensional views, and the
(33:59):
breast radiologist is presentduring a diagnostic test.
Now many women get called backfor a diagnostic test after
having the standard two-viewscreening test.
Please do not panic if thishappens to you, because it
happens to a large percent ofwomen and for many it's just a
breast imager's way of getting abetter picture of the breast.
(34:20):
Digital mammography may make abetter choice for women who are
menstruating or have denserbreasts, as the image can be
clearer and thethree-dimensional or have denser
breasts, as the image can beclearer and the
three-dimensional tomograms mayhave less false positive
callbacks, but they do entailmore radiation.
How often?
Well, some groups say everyyear, starting at 40.
(34:40):
Others say, if you don't have apersonal or family history, you
could get a baseline at 45.
It's probably best to get amammogram after you've had your
period or after you've takenprogesterone, because
progesterone, while it protectsthe uterus, it's more
stimulatory to the breast, andthis is the second half of your
menstrual cycle, right beforeyour period, right after you've
(35:03):
ovulated.
Bone density test why?
Well, it can measure thedensity of your bones, how much
calcium is in your bones, andprovide early signs of
osteoporosis.
And some of the newer testingwhich we have in our center
includes trabecular bone scoring, which actually looks at the
bone architecture andcategorizes your bone
(35:24):
architecture as either normal,partially degraded or degraded.
Well, how often should you geta bone density?
Well, within two years ofmenopause earlier, for patients
with a family history or thosewho've previously broken or
fractured bones.
After age 40, those women whosmoke or have had low calcium
and low vitamin D intakes,people who have been on
(35:44):
prednisone or glucocorticoids,those on long-term
anticonvulsants, those withstrong family histories of
osteoporosis.
If any blood relative of yourshas had a hip fracture even at
an advanced age, you need toconvey this information to your
physician.
Colonoscopy to screen for coloncancer it's usually started now,
(36:08):
at age 45.
We used to do it.
Colon cancer it's usuallystarted now at age 45.
We used to do it at 50, butbecause there's been an
increasing incidence incolorectal cancer in younger
people, we're starting sooner.
There's also stool geneticcoligard testing for those that
don't have a history of polypsand do not have a family history
, if they choose not to havecolonoscopy.
(36:29):
Blood pressure I think thatanyone over age 50 should have
their own blood pressure cuffand have it validated at their
doctor's office to make sure itcorrelates with the doctor's
sphingomomometer.
High blood pressure increasesthe risk of stroke and heart
attack, two of the most commoncauses of morbidity and
mortality in women over age 65.
(36:50):
And a good majority of womenover age 55 have hypertension.
How often should you get yourblood pressure taken?
At least once a year with yourphysician and at least monthly
by yourself at your home if youhave high blood pressure and you
can generally purchase a homeblood pressure monitor at any
drugstore and the digitalmonitors that go around your
(37:13):
bicep, upper arm muscle work thebest.
I don't really like the onesthat are around the wrist.
Cholesterol Well, why do youwant to know your cholesterol?
Because high cholesterol can belinked to heart disease,
hardening of the arteries,stroke and obesity.
If your levels of cholesterolare borderline elevated, you
might want to ask for a cardioCRP or ultrasensitive CRP, which
(37:36):
can measure inflammation levels.
However, if you're on any oralhormones, be them hormonal
contraceptives or menopausalhormone therapy, orally, the
ultrasensitive CRP test will befalsely elevated and not helpful
.
Orally, the ultrasensitive CRPtest will be falsely elevated
and not helpful, and it can bealarming to your doctor or
cardiologist, if they don't knowthis fact, that the oral
(37:57):
hormone therapy, by goingthrough the liver, does cause
this as an epiphenomenon.
Fasting blood sugar why?
Well, you want to detect yourblood sugar and identify signs
of diabetes, and we like to dothis at least every three years,
starting by age 45.
Or earlier, if you've hadgestational diabetes or you've
(38:20):
had a baby over nine pounds oryou've had weight gain or a
family history of diabetes orany signs of any insulin
resistance.
Tsh thyroid stimulating hormone.
Why do we do this?
To detect thyroid dysfunction,which is very common.
One in eight women have thyroidproblems.
How often should you get this?
At least every five years orsooner for patients with
recently elevated cholesterol,new menstrual disorders, new
(38:44):
mood problems and those thathave thyroid problems need to be
monitored more frequently, atleast every year.
Human papilloma tests and thinprep pap test and the pelvic
exam.
Why?
Well, to detect HPV, which isthe most common sexually
transmitted infection, and someof these strains of the virus,
(39:06):
especially 16 and 18, can causecervical cancer.
Other strains can cause genitalwarts.
That being said, 80% of womenby age 50, even if they've only
had one partner and used condoms, can still have had exposure to
HPV.
It's very, very ubiquitous.
If you've always had normal papsmears all of your life and
(39:26):
negative HPV and your mother didnot take DES, you might be able
to discontinue regular papsmears at age 65 because the
at-risk area of the cervix, theopening of the cervix, is no
longer susceptible to HPVinfection.
However, if you haven't beenregularly screened, or if you
have HIV, or if you've hadabnormal PAPs and HPV in the
(39:50):
past or leaps or colposcopies,you may need to screen it longer
.
All women, regardless of age orcondition or sexual activity,
should continue at least withevery two or three year pelvic
exams.
And I can't tell you the numberof women I see who've had
hysterectomy and they say oh, mygynecologist says nothing's
left, I don't need to come in,you still have a vulva, a vagina
(40:14):
, a pelvic floor, musculature,perianal area, rectum.
So periodic exams, which manytimes can be taken care of by a
well-trained and qualifiedwomen's health nurse,
practitioner or physicianassistant, should be
periodically continued.
So in terms of starting papsmears, we used to start them
(40:38):
earlier, at the age of sexualactivity or by 21, but many of
these paps are abnormal becauseof HPV.
So many physicians wait untilage 24, unless there's symptoms
or problems.
Once you're 30, we like tocombine the thin pap along with
the HPV DNA test, and some arejust advocating only for the HPV
(40:59):
DNA test.
But I'm not a fan of this.
I think the co-testing is veryimportant and if you're under
age 30 and you've had anabnormal pap.
It needs to be testedreflexively for HPV and
regardless of your age, youshould be tested every three
years after your initial test.
But if you carry the high-riskHPV or you've been exposed to
(41:23):
DES, you'll need more frequentpaps.
And unfortunately, age isnotwithstanding and a lot of
women have been told they onlyneed it every five years so they
don't see the gynecologist andthat's not a good idea If they
didn't get a good specimen, ifthere was HPV that wasn't 16 or
(41:44):
18, you still need evaluations.
And younger women women withsymptoms do need still their
yearly gynecologic exams.
As a woman gets older and isover age 65, if she's been
screened for cervical cancer andhas never been positive, then
going to every two years isgenerally considered standard
(42:08):
and that's usually what Medicarewill cover.
And if you've had ahysterectomy for benign,
non-cancerous reasons, you don'tneed a pap smear of the cervix
because the cervix is notpresent, but you still need the
exam.
And if you were exposed to DESdiethylstilbestrol, which was
given years ago to women toprevent miscarriage,
(42:29):
unfortunately that could havevery negative effects on the
cervix and vagina of those womenthat were in utero.
You must continue with youryearly PAPs, even if your HPV is
negative.
So I recommend getting a cleanbill of health, including an
exam, thin prep, pap, cervicalcultures if indicated,
particularly if you've changedsexual partners, and in our
(42:51):
Center for Specialized Women'sHealth we have a terrific,
fabulous women's health nursepractitioner who is very adept
at doing this, and many timespatients will see me and see her
on the same day and if they'redue for their bone density, get
that all combined.
So what should you know aboutHPV?
Well, it's very common.
It's a sexually transmitteddisease caused by the human
(43:14):
papillomavirus.
There's over 100 types of HPVand more than 30 of them spread
through sexual contact.
Women who get HPV often don'tknow they have it because the
symptoms can be silent.
Like I said, as many as 80% ofall women have been exposed to
HPV by age 50.
Luckily, in most people theinfection could clear without
(43:38):
problems.
However, poor nutrition, lowvitamin D levels, cigarette
smokers or people justgenetically who cannot clear the
infection, are at risk forcervical cancer, vulvar cancer
and even potentially anal cancer.
Genital HPV can be spread byskin-to-skin contact.
There doesn't have to be anexchange of body fluids like
(44:00):
there is with HIV transmission,and unfortunately, condoms do
not prevent all HPV transmissionand those that have the
high-risk strains of HPV mayhave abnormal tests, and those
with low-risk types can haveminor abnormalities in a pap
smear or might have generalawards.
And although HPV is usuallyharmless, some types can cause
(44:22):
cervical cancer if not detectedin time.
Having regular pap smears isthe best way to ensure that any
precancerous changes to thecells will be caught and treated
early.
And you always want to getresults.
Don't assume no news is goodnews.
You should get copies of thoseresults.
I just can't believe how somany people have more
(44:45):
information about their pethealth or their car updates than
their own personal health, soyou really need to be proactive
about it.
If a woman has a normal pet butis persistently positive for
HPV strains, I definitelyrecommend they get a colposcopy,
which is a microscopic view ofthe cervix, to allow for direct
(45:07):
observation of the cervix forexamination and biopsy of any
suspicious areas.
This procedure can take placein the doctor's office.
In 2006, gardasil was the firstcervical cancer vaccine, which
affects four strains of HPV andit's offered to girls ages 9 and
(45:30):
older up to the age of 26.
And there's a series of threeinjections over six months and
has recently been extended tomales and females up to the age
of 45.
The immunization is generallycompleted within six months
prior to sexual activity.
But even if you've had the HPVvaccine, even if your partner's
(46:00):
had it, you still need regulargynecologic exams and periodic
pap smears.
And HPV has been associatedwith other cancers, such as
throat cancer, anal cancer, lungcancer, penile cancer and
possibly even some forms ofbreast cancer.
And it was first approved forfemales in the United States,
but later was extended to malesas well.
So, on the record, maintainingyour own file my final
(46:24):
suggestion on making the most ofyour physician visit is to give
you an assignment.
A great way to stay in chargeof your own health is to keep
your own detailed medical fileat home, just like you maintain
financial records or details onwhen your car was last serviced.
Please, please, keep your ownmedical file.
And if you don't have yourfiles on hand, you're like most
(46:50):
patients, even doctors andnurses, who don't have their
cholesterol level.
They don't know how many unitsof vitamin D they're taking,
whether they had one or bothovaries removed, whether they
had a full hysterectomy or not,and this information is vitally
important, especially if youswitch physicians, move to a new
city, and while we havetechnology and online medical
records, we all have to takeresponsibility for keeping hard
(47:14):
copies of medical records,particularly surgical reports,
pathology reports, and I thinkit's good for you to be involved
in keeping track of yourmarkers of health.
And you never know whenthere'll be issues with
networking, computer viruses orthe transmission between
different health systems, somaybe some of these practices
(47:37):
are already a habit for you.
A lot of women weigh themselvesonce a week.
They know when they're going toget their menstrual period.
Some people write it down on acalendar or track it on an app.
So why should you bother tokeep a health file?
Well, weight and height candetermine your body mass index,
which can be a factor indetermining your risk for
certain conditions like heartdisease and diabetes.
(48:00):
Even if you're not worriedabout pregnancy, knowing the
dates of your past menstrualcycle can help you and your
health care clinician determinewhether you've started into
perimenopause.
Designate a special file whereyou can keep your records.
Pick out a pink folder, make ithot pink or something that
stands out and listed below isthe information you should
(48:22):
collect.
Keep it handy Don't stick itbehind other files or in the
bottom of a drawer and bringyour folder with you when you
see your physician.
Take the time before theappointment to review your
latest records and be sure tonote questions and concerns you
have.
Bring in medications,supplements with you.
Pictures are not nearly ashelpful because you can't see
(48:44):
everything on the bottle the lotnumber, the expiration date.
Keeping track of your recordsallows you and your physician to
plan the optimum course ofprevention and treatment
together.
Well, what should I put in myfile?
I suggest you compile importantstatistics that you keep at
hand.
Weigh yourself once a week andlist that.
(49:05):
We all know that scale will tipafter an indulgent weekend or
during a certain time of themonth.
Even throughout the day, ourweight can fluctuate several
pounds during the week.
So weigh yourself in themorning and please don't let the
numbers determine your mood oryour dinner plans.
Why is weight important?
Well, the higher your BMI,generally speaking, the higher
(49:27):
disease risk, cholesterol, bloodpressure and diabetes risk.
Also, it can make arthritisworse.
It can contribute toobstructive sleep apnea,
gallbladder disease and severalcancers.
Ultimately, weight gain canaffect the quality of life,
including the way you feel andlook each day.
Height Unfortunately, most of usdo shrink with age and height,
(49:49):
but not in weight.
How many inches we lose can bea sign of our skeletal bone
health.
Weak bones of lower bonedensity eventually translate
into osteoporosis or morefull-fledged bone loss.
That can result in painfulfractures, which can curtail
lifestyle and even lead to deathor nursing home placement.
So get in the habit ofmeasuring yourself, at least
(50:12):
yearly, and generally we do itin the morning, because you tend
to be taller in the morning andlosing for a woman up to 1.5
inches of height can be normaljust from losing some of the
disc space.
Bmi, body mass index.
Unfortunately, we women aremore prone to weight gain than
men because female hormones athigher doses can promote the
(50:35):
female fat deposition, becausewe are the sex that carries
children.
What's more is muscle mass islost, especially after age 40,
in a process known as sarcopenia, and it can be replaced with
body fat.
So the older we get, the harderwe have to work to keep off the
fat because our metabolismslows down.
(50:56):
Bmi is a reliable indicator ofbody fat in many women not all.
Certainly athletes, males,people that have very dense
bones and high musculature canhave a high BMI, but in general,
for most people it's a veryhelpful calculation.
(51:18):
To calculate your BMI.
Take your weight in pounds anddivide your height squared and
multiply by 703.
So if you're a woman who's 5'5and you weigh 155 pounds, you
divide the weight by the heightsquared and you get your BMI,
which is 26, which is borderlineIn general.
(51:40):
If your BMI is less than 18.5,you're underweight.
If you're 18.5 to up to 25,you're normal.
18.5 to up to 25, you're normal.
Once you're 25 to 27, you're inthat borderline category.
Over 27 to 29.9, bmi isoverweight and 30 and over is
(52:05):
obese.
So this mythical woman who'sfive foot five and 155 pounds is
not overweight, but she's kindof teetering and it might be
important to focus on healthyeating, maybe some intermittent
fasting, maybe focusing more onweightlifting to build muscle or
maintain muscle as opposed tothe aerobic activity which can
increase appetite.
But BMI does have limits.
(52:26):
Athletes, individuals that arevery muscular, will have a high
BMI.
My three sons are all athletesand they all have BMIs of 30,
which would be considered obese,and yet they have probably 11%
or less of body fat because youcan see their muscles.
So it's not for everyone.
(52:47):
Following trends and patternsare important.
Sometimes we do body fatanalysis by submerging in water
to calculate a fat percentage.
Our bone density machine canalso calculate lean body mass
and total body fat.
Sometimes we do this when womendon't have enough body fat and
(53:10):
therefore they can't maintainmenstruation and fertility.
So know your family history.
You can't choose your genes,but you can take steps to
mitigate your risk of cancerdiseases and other medical
conditions that run in yourfamily.
If your mother had breastcancer, your risk of getting it
is greater than a woman withouta family history.
(53:30):
It also helps if you knowthings like the age your mother
was when she entered menopause.
Did your grandmother have abroken hip from osteoporosis?
Or maybe it was just a hipreplacement because she had
osteoarthritis a differentcondition.
So the more you know, the moreyou can help control your future
health.
(53:51):
Vitamins, supplements andprescriptive medicines Know
exactly what you're taking andbring those bottles in.
Many women don't mention herbalremedies or non-prescription
treatments, but you should,because they can have
significant impact onmedications, health conditions
and even the effects ofanesthesia if you're having
surgery.
So please speak up about these.
(54:16):
Fasting lipid levels.
Cholesterol ratios can changebefore and right after menopause
.
The same goes for bloodpressure.
Knowing your cholesterol isimportant to identify risk for
heart disease, diabetes andstroke your physician can give
you a referral to a laboratoryto test your lipids Blood
pressure.
The guideline for women is about115 over 75, and many of my
(54:36):
patients exceed this.
I recommend checking your bloodpressure in the morning, as it
tends to be a bit higher.
Wait at least 30 minutes afterhaving coffee or caffeine.
Check your blood pressure underdifferent circumstances, such
(54:57):
as when you're relaxed or 30minutes after exercise or when
you're feeling anxious or tense.
If you continue to log highblood pressure readings, do not
wait for an annual checkup to dosomething about it.
What does my blood pressurereading actually mean?
Well, a healthy heart beats ina predictable cycle and it
contracts and relaxes, so youget a systolic and a diastolic
level.
Some people have elevations ofboth.
(55:19):
In either case, it's veryimportant to control high blood
pressure and it's important tonot make excuses like well, you
know I'm stressed or I don'tlike seeing the doctor, so there
can be other complaints thatpeople have.
But if it's elevated it canlead to stroke, heart failure,
(55:40):
kidney failure, hemorrhages inthe blood vessel or peripheral
vascular disease.
If your blood pressure is 120over 80, that's not normal,
that's prehypertension.
So shoot for 115 over 75 orless.
Please keep results of testssuch as your last bone density.
Many insurances will only coverit every 24 months.
(56:02):
When was your most recentmammogram?
Many insurances require it tobe 366 days from the last
mammogram.
Do you have your blood levelresults?
Other records?
What screenings have you hadfor cancer?
Do you have a durable power ofattorney and advanced health
(56:24):
care directives.
And so you're ready to roll.
Now you know what you need todo to find a doctor, what
questions to answer, what teststhat you need, what to expect
and how to keep track of yourhealth information.
So you have the knowledge andthe tools and you're ready to be
(56:47):
a full partner in your healthcare.
So you have been in theSunflower House with your host
and author, Dr Holly Thacker.
Thanks so much for joining us.
Please subscribe to our podcaston any of the channels and give
us a rating, and please be sureto join me back in the
(57:08):
Sunflower for chapter twosymptoms of menopause.
Welcome.
This is a special edition ofthe Speaking of Women's Health
podcast.
I am your host, dr HollyThacker, and I'm also the author
of the book the ClevelandClinic Guide to Menopause
Everything you Need to Know toThrive During Menopause.
(00:32):
So I'm beginning the first of apodcast series of this book.
This book was published andI'll be updating it along the
the way by Kaplan Publishing inNew York.
Some of the reviews I'll read toget you interested and I'll be
(00:52):
doing one chapter at a time soyou can listen to the whole book
or just, based on the titles ofthe chapters, you know, listen
to the ones that you'reinterested in.
So this was from Dr ElizabethHB Mandel, who is an associate
professor of the Department ofOBGYN at the University of
Virginia and she was on theNorth American Menopause
(01:15):
Consumer Education Committee.
Her quote about this book ismidlife women who are feeling
betrayed by the unpredictabilityof their bodies and overwhelmed
by conflicting claims of themedia will find clarity and
empowerment in the pages of thisbook.
Dr Thacker demystifiesmenopause by using simple
(01:37):
language to explain how thedecline of estrogen levels can
manifest itself as a broad arrayof symptoms, and she offers
practical strategies for copingwith these symptoms.
The author acknowledges thateach woman's approach to
menopause with a unique set ofchallenges genetic risk,
surgical history, medicalhistory, family stressors and
(01:57):
she invites the reader toexplore different options for
meeting these challenges.
This is an empowering messagefor all ages.
The next review is by SylviaMorrison, a marketing executive.
Dr Thacker is thequintessential physician
advocate for women and ourhealth.
Her advice is sound, thoroughand easy to follow.
(02:18):
Dr Thacker empowers you to makegood choices at so many levels.
And then finally, dr WendyKlein, associate Professor of
Medicine, obgyn at the VirginiaCommonwealth University School
of Medicine, and was a DeputyEditor of the Journal of Women's
Health states quote theCleveland Clinic Guide to
Menopause is rich with practical, scientifically grounded advice
(02:42):
for healthy living.
It's filled with soundstrategies for dealing with the
challenges of aging gracefully.
This is a must-read book thatwill help empower women during
midlife.
Okay, so let's begin theCleveland Clinic Guide to
Menopause and I dedicated thisbook.
(03:02):
It's my pleasure to dedicatethis book to you, the reader,
and now the listener, and tothousands of women I've had the
privilege of treating during myyears of practice in
interdisciplinary women's health.
I am so glad to beginpodcasting this book.
My middle son, emerson, told mefour or five years ago that I
(03:25):
needed to get right involved inpodcasting and I knew that I
should.
But I'm so glad to be gettingaround to doing it.
And part of the reason why wedecided to start to podcast at
Speaking of Women's Health, ournonprofit, which you can visit
at speakingofwomenshealthcom, isbecause we did have a medical
(03:46):
grant from Estellas and Bayer tohelp educate physicians and
nurses and pharmacists aboutvasomotor hot flashes in women
and some exciting research andsome potential upcoming options
and products that we'reexpecting on the market in 2023.
So I have done three types ofpodcasting.
(04:09):
One is for laywomen.
That includes a lot of greatinformation that we have on our
website, which has social mediaand free treatment guidebooks
and breaking health news andrecipes.
So please visitspeakinginwomenshealthcom news
and recipes.
So please visitspeakingofwomenshealthcom, the
Medical CME podcast, which isfor free medical credit for
(04:37):
physicians, advanced practiceproviders and other folks in the
healthcare arena.
Many of our women listenersalso enjoy listening to those
interviews of prominentphysician experts.
So the third series ispodcasting this book and it was
published in 2009.
It's now February of 2023.
(04:58):
And instead of writing a thirdbook, because this is actually
my second book, instead ofwriting a third book, because
this is actually my second book.
I've worked on the websiteregularly and updated that
almost on a daily basis, and sothat's why I never really felt
the need to write a book.
And even though this book waspublished in 2009, and there's
been a lot of scientificadvances, new treatment options,
(05:20):
most of all, the basicinformation about perimenopause,
menopause, hormonal therapyissues that affect women at
midlife really are prettysimilar, and the nice thing
about podcasting is I can justupdate this as we go.
So I'm going to start with theintroduction and chapter one,
(05:41):
which is choosing and seeing adoctor at midlife.
So my introduction is so you'rea woman facing midlife and you
care about your health.
So you read the headlines andyou tune into news programs, and
if you miss the story of theday, you can count on a friend
to fill you in.
(06:01):
Or perhaps you get a news feedcontinuously on your cell phone.
Get a news feed continuously onyour cell phone.
So daily so-called cutting-edgereports that spout the latest
findings on women's healthbreakthrough medications,
warnings about therapy, newweight loss fads, breast cancer
rates they just seem to betalking to you.
So midlife can be a good timeto take stock of your health and
(06:25):
feel invigorated and plan foryour second adulthood.
For many women, it's just amarvelous time, but other women
spend midlife barely stayingafloat, frantically, dog
paddling in a sea of turbulentsymptoms that affects their work
, their health, their sleep,mood, sex life and happiness.
And if that wasn't enough, theyalso have to deal with a
(06:47):
barrage of mixed messages.
You might hear that newresearch indicates new low-fat
diets won't prevent heartdisease.
Or maybe you hear that avoidingall carbs will not help you
lose weight.
Or that all hormone therapy isdangerous.
That's not true.
Or those vitamins you're takingare worse.
One day your prescription's amedical miracle, the next day
(07:09):
it's a killer.
Talk about frustrating.
If this were true, or evenpartly accurate, being a woman
today would be quite the riskybusiness, but this should be the
best time in history to be amidlife woman, thanks to the
availability of so many safe andeffective options for staying
in great health.
Instead, though, I see drovesof women suffering because of
(07:32):
alarmist reports that havescared them away from proven,
safe, effective therapies, andthey're receiving erroneous
information and not as muchsupport from their health care
clinicians as they would like.
I see women weeping fromfatigue after they've gone off
hormone therapy becausesheet-soaking nighttime hot
flashes have robbed them ofsleep and left them exhausted.
(07:56):
I see depressed women broughtin by their husbands because the
sex drives vanished or thatthey're enduring random panic
attacks that make them feel likethey've lost control over their
lives.
I've seen women who've stoppedeffective osteoporosis therapies
because they're petrified theirjaw is going to drop off.
But in my then it was 20 years.
(08:18):
Now it's 30 years of practicingmedicine with a focus on
midlife women's health andmenopausal hormone therapy.
I haven't seen things as bad asthey've been post-women's
health initiative and thatreport was released in 2002, and
I just did a podcast about the20th year anniversary.
(08:39):
So my daily contact with womenand doctors and students in
training have shown me that toomany people, both in and out of
the medical field, have receivedmixed messages about women's
health.
But in spite of this, thespecialty field of women's
health and collaborative healthcare has really come alive.
(09:01):
I established our Center forSpecialized Women's Health at
the Cleveland Clinic in April of2002.
That was just three monthsbefore the headlines were
exploding with the exaggeratedreports of the so-called dangers
of hormone therapy.
When we opened the center, Ilaunched a for her telephone
(09:23):
hotline 216-444-4HER, which is4437, which women could call
with questions, concerns, makeappointments and have several
options.
(09:45):
And health, whether it'sholistic health, menopausal
health, bone health.
Many people are still deprivedof really crucial information
that could mediate theirneedless suffering and correct
the distorted media claims andimprecise research surrounding
women's midlife health issues.
So this book provides thatmissing information.
In the following chapters,we're going to focus on vitality
, health maintenance, hormones,hormone therapy, sleeping
(10:09):
problems, cancer prevention,bone health, depression, panic
attacks, heart health, sexualhealth and the truth about
vitamins and supplements, aswell as talk about some cutting
edge therapies for women'smidlife concerns.
So if you've picked up thisbook or you're listening to this
podcast, chances are you'llrecognize the struggles that
(10:30):
some of my patients share asthey cope with midlife.
I hope that I can help dispeldistorted media claims and
inaccurate interpretations ofresearch that misled and confuse
women and their doctors.
Most of all, I hope readingthis book or listening to this
book will give you peace of mindand offer sound, practical
(10:51):
information to help you regaincontrol of your health during
midlife.
After all, it's your body, yourhormones and your choices.
By the way, that was the titleof my first book.
So by listening to this book,you're taking the initiative for
better health and renewedvitality.
So congratulations, you are onyour way Getting answers.
(11:17):
Each stage of life brings newchanges and gives rise to new
questions.
We need answers that will helpmake our transitions smoother
and guide us into maintaining agood quality of life.
Unfortunately, we are manytimes misled.
The headlines don't spell outthe whole story and even
in-depth reports can leave outcritical research conclusions or
(11:40):
just jump to a conclusion tocreate media hype.
We've certainly seen a lot ofthat in the last few years
during this COVID pandemic.
The existence of so manyvariables can affect whether the
results of the research studyeven apply to you, and like I've
always said to my residents,fellows and medical students, is
(12:04):
that one study is just a pieceof the puzzle.
It's not the whole entirepicture, and you need a lot of
pieces of the puzzle before youcan see the big, bigger picture,
much less complete it.
So there's no doubt thatsometimes the media can be
helpful.
News programs, magazines,internet websites make us
(12:24):
realize how much information isout there and how many people
are committed to finding answersthat women can live the
healthiest, happiest and longestlives possible.
Many findings are inspiring andmore research is always on the
way, but the truth remains.
Most women are confused, andwho can blame them?
(12:45):
What's the real story?
Whom can you trust to give youanswers when those answers are
constantly changing?
Within the pages, you will findinformation on the following
Controlling menopausal symptoms.
The truth about vitamins andsupplements.
Diet and exercise to boostenergy.
Bone health basics.
(13:06):
Myths and facts about hormonetherapy.
Helping your heart in midlife.
Preventing cancer and otherdiseases.
Recharging your sex life.
Improving your vitality,longevity and quality of life.
Women's health specialists likemyself and others at the
Cleveland Clinic Center forSpecialized Women's Health have
(13:27):
dedicated our career to studying, researching and treating
women's health issues With sotight a focus.
Such doctors are better able tosee that big picture because we
have more of the puzzle pieces,and the Cleveland Clinic guides
are designed to help you fitall these pieces of the puzzle
together for your life.
We are all women, but we areall different, and you don't
(13:51):
need a physician to tell youthat we're all different.
Just look at your mother andsisters and girlfriends and
colleagues.
It should come as no surprisethat there's no one-size-fit-all
prescription that will calmraging hormones or restore
balance during a time of lifewhen change is the only constant
.
It is a fundamental truth inwomen's health that there isn't
(14:13):
a simple yes or no answer forevery question, including is
hormone therapy a solution forevery woman?
Can you tell whether or notyou'll get a difficult menopause
or perimenopause?
Tell whether or not you'll geta difficult menopause or
perimenopause?
Should you keep taking birthcontrol in early menopause?
Are antidepressants a good idea?
How can you stop hot flashesand get a good night's sleep?
(14:34):
Are there hysterectomyalternatives?
Can I get my sex drive back theway it was?
Is surgery the best answer fora leaky bladder?
The media likes to categorizeeverything as just good or bad,
but with women's health thisisn't just quite simple and
possible.
The only rules that apply toeveryone is don't smoke and wear
(14:56):
your seatbelts, and that'sabout it.
Even with diet and exercise,vitamin supplements, health
recommendations vary from personto person.
We all need a little somethingdifferent to look and feel our
best.
Using information gatheredduring the physical exam routine
test that can range from bloodpressure readings to mammogram
(15:18):
to bone density is like playinga card game Everyone gets a
different hand becauseeveryone's issues combine
differently.
The key is to develop astrategy based on the cards
you're dealt.
That's why it's critical tofind a physician experienced in
treating these midlife women'shealth issues.
It's also important to know theinformation you should have
about your own health and whatquestions you should ask.
(15:40):
What treatments are available,both medical and holistic, that
will enable you to maintain avital lifestyle.
You need to build yourknowledge.
Invest in yourself by gettingthe straight facts about you,
not your friend, not yourneighbor or mother or colleague
A strange disconnect.
When women come to see me thefirst time, they're usually
(16:03):
eager to request the mostcomplex, recently touted medical
test, but sometimes they don'tseem to know the basics of
everyday preventive health andthere's sometimes a disconnect
between what women really needand what they ask for.
For example, I have women thatask for that CA-125 blood test
(16:24):
that monitors for ovarian cancer.
This may be a helpful tool inevaluating how a woman is
responding to cancer treatment,but it's not a good screening
test for ovarian cancer becauseit yields a high rate of false
positives and it also can missearly cases of ovarian cancer.
And sadly I've seen manyotherwise healthy women who had
(16:44):
their healthy ovaries removedbecause that CA-125 test was
elevated, not because of cancerbut because of common,
relatively benign conditionslike fibroids or endometriosis.
And it baffles me when the samepatient who asked for
non-diagnostic ovarian cancertesting doesn't even know the
symptoms of the disease whichshe could be looking for.
(17:07):
Though subtle, there are signsyou can watch for Pelvic pain,
discomfort, pressure, changes inbowel movements such as
frequency and consistency,changes in urination or sudden
urgent need to urinate, painduring sexual intercourse,
abdominal pain, swelling or afull or bloated feeling,
persistent fatigue, weight gainaround the abdomen, along with
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either sudden weight gain orsudden weight loss.
Many women don't know how tolisten to their bodies.
We haven't been trained in thisrelatively simple yet important
art.
In addition, we haven't beengiven reliable information.
For example, did you know thatusing the hormonal oral
contraceptive pill for fiveyears can dramatically reduce
(17:53):
your risk of getting diagnosedwith ovarian cancer?
Or that pregnancy andbreastfeeding also reduce this
risk?
Do you know it's been estimatedthat several cancer disease
risks could be reduced by 70% ormore simply by optimizing your
vitamin D levels?
This is not to say that allwomen should take the birth
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control pill or get pregnant ordose themselves without
supervision.
On vitamin D.
Remember there are no absolutesin women's health, vitamin D.
Remember there are no absolutesin women's health.
Many educated women, even somewho are physicians, are not even
aware of cancers and otherdiseases in which they have
influence over.
The point is that, while manypatients ask for tests they've
(18:35):
heard about on the internet,like CA-125, that are not
usually helpful, many times theyneglect crucial basic
guidelines for good health.
This book will give you theinformation you need to do
everything that you can toensure your own good health and
vitality, and then you'll be inthe best position to make use of
the screening test and thetherapeutic treatments that your
(18:58):
doctor and you believe willhelp you live a long life.
It's all about the choices.
They say that knowledge ispower, but I'd like to make the
case that the right knowledge ispower.
When we understand our options,we can make better choices.
We can gain control over ourhealth, feel good about
(19:25):
ourselves as our bodies changeand mature, and enjoy our
relationships with friends andfamily more fully.
My goal is to share with youwhat we really know about
menopausal process, to dispelmyths about treatments like
hormone therapy, and to discussthe many ways you can maintain
(19:45):
good health and improve areas ofconcern.
Midlife is the beginning of atime when most women can focus
on their passions.
You've spent years raisingchildren or caring for a spouse
or family member, or maintaininga career, being a best friend,
sister and active communitymember.
Now it's time to take care ofyou, and I am your host, dr
(20:12):
Holly Thacker.
I'm the director of our Centerfor Specialized Women's Health
at the OBGYN and Women's HealthInstitute at the Cleveland
Clinic, and I am a professor ofboth medicine and OBGYN and
reproductive biology, and I amthe executive director of
Speaking of Women's Health, ourwebsite
speakingofwomenshealthcom, and Iam the fellowship director for
(20:37):
our specialized women's healthfellowship.
So moving on to chapter one.
It so moving on to chapter onechoosing and seeing a doctor at
midlife.
So, women, we are just naturalswhen it comes to sharing.
When we listen, we really hear,and when we talk, we express
our deepest worries and greatestjoys and form real connections
(20:58):
with our best friends, oursisters, mothers, co-workers and
neighbors.
Our male counterparts mightcall these verbal exchanges
chatter, but we women knowbetter and because we're so
practiced in reaching out anddiscussing personal issues, of
course we're able to find theright support we need when we're
worried about our health, right?
Well, not exactly so.
(21:20):
Does this case scenario soundfamiliar?
This is Ellen.
I haven't slept an entire nightin ages because these hot
flashes and night sweats.
If this keeps up, I don't knowhow I'm going to manage to keep
my job.
And with my daughter's weddingcoming up in three months, not
to mention my mother's kneereplacement, I'm not sure
there's going to be enough of meto go around.
(21:40):
I wonder if hormone therapywould help.
So I decided to ask my nextdoor neighbor.
After all, she's already beenthrough this.
Well, judy said she never tookhormones during menopause, since
their safety seemedquestionable.
And she doesn't seem any worsefor the wear.
She seems happy and healthy andthe way she and her husband
behave.
You think they werehoneymooning Now in my bedroom.
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On the other hand, yes,emotional support is just what
women need.
In fact, there's research toshow that women with strong
friendships and support systemsrecover from illness better than
women who are more isolated.
You simply cannot put a pricetag on the value of human
connection and empathy.
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Hearing and affirming me too,from a best friend might be just
the thing that pulls you out ofa funk, but that's not all you
need.
The right answers for yourneighbor may not be the right
answers for you.
Judy never took hormones andyet she enjoys a great sex life
(22:43):
Nonetheless, hormones mayalleviate your menopausal
symptoms, as they did for Ellen,allowing her to fully
participate in her daughter'swedding preparations, support
her mother after majororthopedic surgery, sleep better
and therefore perform better atwork and, just as important,
ignite some of that missing mojoin the bedroom.
So go ahead and talk withfriends and family, get
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emotional support that you need,but when you're seeking medical
advice, don't leave your doctorout of the picture.
After all, mother, even yourmother, doesn't always know best
.
But where can you find a doctoryou can trust, one who's
knowledgeable about the ins andouts of women's health at
midlife?
I wrote this book in large partbecause I was so dismayed that
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smart women were seeingotherwise good doctors who gave
them inaccurate informationabout all their women's health
options.
I cannot stress strongly enoughthe fact that women are
different.
We have different needs fromthose of men, children and even
one another, and during the timefrom peri to post-menopause,
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starting at around age 40, fromperi to postmenopause, starting
at around age 40, we may need aphysician specialist who can
address the concerns unique tous.
Question is my OBGYN enough?
Many women obtain all or mostof their women's specific health
care from their OBGYN.
It seems to make sense on thesurface.
After all, obgyns specialize inwomen's health, don't they?
(24:09):
But depending on the nature oftheir medical practice, primary
care doctors and OBGYNphysicians may or may not focus
specifically on the healthconcerns of midlife women.
Some women's health specialists, such as North American
Menopause Society, credentialedspecialists, may have some
knowledge, experience orresources that you need, and you
(24:30):
can certainly go onmenopauseorg and then put in
your zip code and find a list ofpractitioners who have at least
taken a basic test on menopauseand shown interest in this
field.
So whom should you trust withyour health?
Well, it all depends.
Should I see a specialist?
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If you have significant peri orpostmenopausal symptoms, such as
panic attacks, hot flashes,sexual dysfunction, problems
that disrupt your life orserious health disorders like
osteoporosis, you may want toconsider making an appointment
with a physician whospecifically concentrates on
women's health during midlife.
His or her practice shouldencompass a knowledge of
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menopausal and hormone therapy,bioidentical and otherwise bone
health, osteoporosis evaluation,sexual health, gynecologic
services available on site, suchas pelvic exams and pap smears,
urinary incontinenceevaluations, mammograms and
breast health, breast healthrisk assessment, as well as
(25:35):
holistic expertise and optionsin nutrition, exercise and mood
disorders.
Because menopause is a normallife stage.
Some women imagine that theymust be weak if they need extra
help, but this isn't furtherfrom the truth.
After all, pregnancy anddelivery are natural life stages
and most women seekprofessional support, education
(25:58):
and sometimes even medicalintervention during these stages
.
So it's especially important tosee a women's health specialist
if you have a personal orfamily history of breast or
ovarian cancer, you'veexperienced blood clots, you've
had previous adverse reactionsto medications, you have a
personal or family history ofhormonal upheaval, or you've
(26:18):
been told that you need ahysterectomy and have no other
options that are presented.
Strong women take control oftheir health, and that means
seeking specialists who canprovide the support and
treatment options needed.
And just because someone saysthey specialize in women's
health or hormone therapydoesn't mean they actually have
the credentials.
(26:38):
And there are, unfortunately,shady people in the field that
have seized on the opportunityto profit from women's misery
and confusion opportunity toprofit from women's misery and
confusion.
So be wary of any of theseso-called professionals who sell
you supplements, concoctionsand so-called individualized,
compounded hormones that theydirectly profit from, all the
(27:02):
while claiming falselyreassuring you that their
personalized therapies aretotally risk-free and totally
natural.
When something sounds too goodto be true.
It usually is.
So what can I expect from agood physician?
Many women hit their emotionaland physical peaks at midlife
(27:23):
and they breeze throughmenopause.
Some make such a seamlesstransition they don't even
realize that they have gone intomenopause.
But most of these women I seeare not quite this lucky.
Their lives have been thrownoff balance as they enter
midlife.
Take Cheryl Well, cheryl'shusband of 23 years brought her
in for an appointment.
(27:44):
He didn't know what else hecould do to support his wife.
She was quote falling apart.
You'd never know it from just acasual glance.
Her appearance was flawless,she was dressed in elegant
pantsuit and she looked quitehealthy, but her eyes told a
different story.
Once in my office she describedthe symptoms she was
experiencing, and they turnedout to be worse than what most
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women experience.
Escalating mood swings abruptlynoseosedived into emotional
crashes, making her feel out ofcontrol.
Her hot flashes were so suddenand substantial that she would
find herself completely soakedin sweat, having to change her
bedsheets.
Her sex life was sufferingtremendously because her vagina
had virtually shriveled up, andthis was particularly upsetting
(28:27):
to her because she and herhusband shared a deep love and
had previously had an enjoyablesex life.
As she was telling me all ofthis, she broke down and sobbed.
It turned out that Cheryl'sprevious doctor had prescribed
hormone therapy to restorehormonal balance and control her
symptoms, and the treatmentworked well.
But the doctors later pulledher off the drugs in response to
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those controversial reports inthe medical and lay press that
so-called infamous women'shealth initiative.
For Cheryl, stopping thetreatments was the worst choice
possible.
So red flags, be wary if yourhealth care clinician imparts
absolutes.
Women's health issues are neverblack and white.
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Answers to critical questionssuch as the following depend on
the individual when should I geta mammogram?
What kind of breast imaging isbest for me?
Is hormone therapy the onlyanswer to treating menopausal
symptoms?
Is my depression due tomenopause?
These questions do not alwayshave simple yes or no answers.
Every woman needsindividualized options,
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education and support.
So if your doctor gives you asimplistic answer, move on.
You deserve better.
Granted, cheryl's case issomewhat extreme.
The severity of her complaintsare uncommon, but to one degree
or another, many womenexperience similar symptoms.
So no matter what physician youchoose, she or he should be
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thorough and caring indiscussing and exploring your
symptoms, whether these symptomsare serious or more moderate.
During an initial appointmentwith a woman at midlife, I ask a
lot of questions.
This allows the patient toframe and express her concerns
and difficulties.
I tend to ask questions inlayers, first touching on the
(30:18):
health history and thenprogressing specifically to
menopausal symptoms.
If these symptoms seemespecially disruptive, I dig
even deeper.
From these questions and anexam I can generally spot
indications if a woman issuffering unnecessarily.
So I ask about what was the ageof your first menstrual period?
When did you give birth to yourfirst child?
(30:40):
If you had a child, did youbreastfeed?
If you had a child, have youhad any breast biopsies?
What are the results?
Do you have a family history ofany breast or ovarian cancers
or are there any cancersyndromes in the family?
When did you have your lastthin prep pap with HPV human
papilloma virus testing?
What's your cholesterol ratios,fasting blood sugar?
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Have you had a mammogram or anykind of colon cancer screening?
Have you had a bone density,had a colon cancer screening?
Have you had a bone density?
If you're menopausal, what isyour history?
When did your period stop?
And if you had an ablation oryou have a Mirena intrauterine
system, did you get yearlyhormone checks to find out when
you went into menopause.
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Have you had any abnormalbleeding?
What conventional or alternativetreatments, such as vitamins,
herbs and supplements, are youtaking?
What are your sleep patternslike?
Do you have trouble fallingasleep or staying asleep when
you wake up, do you fall asleepquickly?
Do you have any troublebreathing or snoring loudly?
Do you notice any shortness ofbreath during the day?
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Do you have any heartpalpitations?
Do you experience hot flashesor flushing?
Is the vaginal genital area dryor irritated?
Have you noticed any changes inyour skin, nails, hair?
What about changes in bowelmovement or bladder function?
How's your sex life?
What's your mood and energylike on most days?
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Have you lost pleasure inactivities you previously
enjoyed?
Do you feel anxious ordepressed?
Do you notice if your anxietyor depression changes in
relationship to your menstrualcycle?
Do you have a personal orfamily history of fibroids or
hormone problems?
Have you ever experiencedpostpartum depression or severe
(32:29):
premenstrual syndrome, pms?
Ever have a history of anybipolar disorder or mania?
A patient's answers to thesequestions help separate some
classic menopausal symptoms frommedical conditions, psychiatric
problems or lifestyle issues,such as being under stress, from
raising teenagers and caringfor aging parents or having
excessive pressure at work.
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And it can be challenging totease out what symptoms are
hormone-related from thosecaused by mental health or
environmental stressors.
An exam and questions such asthese are an excellent start.
Routine tests and screenings.
When caring for a woman inmidlife, a physician should
perform some tests andscreenings.
When caring for a woman inmidlife, a physician should
perform some tests andscreenings.
If you've chosen a newphysician, getting what is
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called baseline scores on thesetests may help your physician
establish what's normal for you.
Knowing what scores you haveallows the physician or nurse
practitioner to trackimprovements or declines over
the months or years in betweenyour visits.
We do have an appendix onpreventive health practices and
other tips for midlife women.
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So what are some of the testsyou might want to consider?
A mammogram it's a screen forbreast cancer.
A diagnostic mammogram isordered if you or your physician
identify a specific change orabnormality in the breast,
because it may involve spotviews or magnification views and
it may include ultrasound orthree dimensional views, and the
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breast radiologist is presentduring a diagnostic test.
Now many women get called backfor a diagnostic test after
having the standard two-viewscreening test.
Please do not panic if thishappens to you, because it
happens to a large percent ofwomen and for many it's just a
breast imager's way of getting abetter picture of the breast.
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Digital mammography may make abetter choice for women who are
menstruating or have denserbreasts, as the image can be
clearer and thethree-dimensional or have denser
breasts, as the image can beclearer and the
three-dimensional tomograms mayhave less false positive
callbacks, but they do entailmore radiation.
How often?
Well, some groups say everyyear, starting at 40.
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Others say, if you don't have apersonal or family history, you
could get a baseline at 45.
It's probably best to get amammogram after you've had your
period or after you've takenprogesterone, because
progesterone, while it protectsthe uterus, it's more
stimulatory to the breast, andthis is the second half of your
menstrual cycle, right beforeyour period, right after you've
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ovulated.
Bone density test why?
Well, it can measure thedensity of your bones, how much
calcium is in your bones, andprovide early signs of
osteoporosis.
And some of the newer testingwhich we have in our center
includes trabecular bone scoring, which actually looks at the
bone architecture andcategorizes your bone
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architecture as either normal,partially degraded or degraded.
Well, how often should you geta bone density?
Well, within two years ofmenopause earlier, for patients
with a family history or thosewho've previously broken or
fractured bones.
After age 40, those women whosmoke or have had low calcium
and low vitamin D intakes,people who have been on
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prednisone or glucocorticoids,those on long-term
anticonvulsants, those withstrong family histories of
osteoporosis.
If any blood relative of yourshas had a hip fracture even at
an advanced age, you need toconvey this information to your
physician.
Colonoscopy to screen for coloncancer it's usually started now,
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at age 45.
We used to do it.
Colon cancer it's usuallystarted now at age 45.
We used to do it at 50, butbecause there's been an
increasing incidence incolorectal cancer in younger
people, we're starting sooner.
There's also stool geneticcoligard testing for those that
don't have a history of polypsand do not have a family history
, if they choose not to havecolonoscopy.
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Blood pressure I think thatanyone over age 50 should have
their own blood pressure cuffand have it validated at their
doctor's office to make sure itcorrelates with the doctor's
sphingomomometer.
High blood pressure increasesthe risk of stroke and heart
attack, two of the most commoncauses of morbidity and
mortality in women over age 65.
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And a good majority of womenover age 55 have hypertension.
How often should you get yourblood pressure taken?
At least once a year with yourphysician and at least monthly
by yourself at your home if youhave high blood pressure and you
can generally purchase a homeblood pressure monitor at any
drugstore and the digitalmonitors that go around your
(37:13):
bicep, upper arm muscle work thebest.
I don't really like the onesthat are around the wrist.
Cholesterol Well, why do youwant to know your cholesterol?
Because high cholesterol can belinked to heart disease,
hardening of the arteries,stroke and obesity.
If your levels of cholesterolare borderline elevated, you
might want to ask for a cardioCRP or ultrasensitive CRP, which
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can measure inflammation levels.
However, if you're on any oralhormones, be them hormonal
contraceptives or menopausalhormone therapy, orally, the
ultrasensitive CRP test will befalsely elevated and not helpful
.
Orally, the ultrasensitive CRPtest will be falsely elevated
and not helpful, and it can bealarming to your doctor or
cardiologist, if they don't knowthis fact, that the oral
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hormone therapy, by goingthrough the liver, does cause
this as an epiphenomenon.
Fasting blood sugar why?
Well, you want to detect yourblood sugar and identify signs
of diabetes, and we like to dothis at least every three years,
starting by age 45.
Or earlier, if you've hadgestational diabetes or you've
(38:20):
had a baby over nine pounds oryou've had weight gain or a
family history of diabetes orany signs of any insulin
resistance.
Tsh thyroid stimulating hormone.
Why do we do this?
To detect thyroid dysfunction,which is very common.
One in eight women have thyroidproblems.
How often should you get this?
At least every five years orsooner for patients with
recently elevated cholesterol,new menstrual disorders, new
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mood problems and those thathave thyroid problems need to be
monitored more frequently, atleast every year.
Human papilloma tests and thinprep pap test and the pelvic
exam.
Why?
Well, to detect HPV, which isthe most common sexually
transmitted infection, and someof these strains of the virus,
(39:06):
especially 16 and 18, can causecervical cancer.
Other strains can cause genitalwarts.
That being said, 80% of womenby age 50, even if they've only
had one partner and used condoms, can still have had exposure to
HPV.
It's very, very ubiquitous.
If you've always had normal papsmears all of your life and
(39:26):
negative HPV and your mother didnot take DES, you might be able
to discontinue regular papsmears at age 65 because the
at-risk area of the cervix, theopening of the cervix, is no
longer susceptible to HPVinfection.
However, if you haven't beenregularly screened, or if you
have HIV, or if you've hadabnormal PAPs and HPV in the
(39:50):
past or leaps or colposcopies,you may need to screen it longer
.
All women, regardless of age orcondition or sexual activity,
should continue at least withevery two or three year pelvic
exams.
And I can't tell you the numberof women I see who've had
hysterectomy and they say oh, mygynecologist says nothing's
left, I don't need to come in,you still have a vulva, a vagina
(40:14):
, a pelvic floor, musculature,perianal area, rectum.
So periodic exams, which manytimes can be taken care of by a
well-trained and qualifiedwomen's health nurse,
practitioner or physicianassistant, should be
periodically continued.
So in terms of starting papsmears, we used to start them
(40:38):
earlier, at the age of sexualactivity or by 21, but many of
these paps are abnormal becauseof HPV.
So many physicians wait untilage 24, unless there's symptoms
or problems.
Once you're 30, we like tocombine the thin pap along with
the HPV DNA test, and some arejust advocating only for the HPV
(40:59):
DNA test.
But I'm not a fan of this.
I think the co-testing is veryimportant and if you're under
age 30 and you've had anabnormal pap.
It needs to be testedreflexively for HPV and
regardless of your age, youshould be tested every three
years after your initial test.
But if you carry the high-riskHPV or you've been exposed to
(41:23):
DES, you'll need more frequentpaps.
And unfortunately, age isnotwithstanding and a lot of
women have been told they onlyneed it every five years so they
don't see the gynecologist andthat's not a good idea If they
didn't get a good specimen, ifthere was HPV that wasn't 16 or
(41:44):
18, you still need evaluations.
And younger women women withsymptoms do need still their
yearly gynecologic exams.
As a woman gets older and isover age 65, if she's been
screened for cervical cancer andhas never been positive, then
going to every two years isgenerally considered standard
(42:08):
and that's usually what Medicarewill cover.
And if you've had ahysterectomy for benign,
non-cancerous reasons, you don'tneed a pap smear of the cervix
because the cervix is notpresent, but you still need the
exam.
And if you were exposed to DESdiethylstilbestrol, which was
given years ago to women toprevent miscarriage,
(42:29):
unfortunately that could havevery negative effects on the
cervix and vagina of those womenthat were in utero.
You must continue with youryearly PAPs, even if your HPV is
negative.
So I recommend getting a cleanbill of health, including an
exam, thin prep, pap, cervicalcultures if indicated,
particularly if you've changedsexual partners, and in our
(42:51):
Center for Specialized Women'sHealth we have a terrific,
fabulous women's health nursepractitioner who is very adept
at doing this, and many timespatients will see me and see her
on the same day and if they'redue for their bone density, get
that all combined.
So what should you know aboutHPV?
Well, it's very common.
It's a sexually transmitteddisease caused by the human
(43:14):
papillomavirus.
There's over 100 types of HPVand more than 30 of them spread
through sexual contact.
Women who get HPV often don'tknow they have it because the
symptoms can be silent.
Like I said, as many as 80% ofall women have been exposed to
HPV by age 50.
Luckily, in most people theinfection could clear without
(43:38):
problems.
However, poor nutrition, lowvitamin D levels, cigarette
smokers or people justgenetically who cannot clear the
infection, are at risk forcervical cancer, vulvar cancer
and even potentially anal cancer.
Genital HPV can be spread byskin-to-skin contact.
There doesn't have to be anexchange of body fluids like
(44:00):
there is with HIV transmission,and unfortunately, condoms do
not prevent all HPV transmissionand those that have the
high-risk strains of HPV mayhave abnormal tests, and those
with low-risk types can haveminor abnormalities in a pap
smear or might have generalawards.
And although HPV is usuallyharmless, some types can cause
(44:22):
cervical cancer if not detectedin time.
Having regular pap smears isthe best way to ensure that any
precancerous changes to thecells will be caught and treated
early.
And you always want to getresults.
Don't assume no news is goodnews.
You should get copies of thoseresults.
I just can't believe how somany people have more
(44:45):
information about their pethealth or their car updates than
their own personal health, soyou really need to be proactive
about it.
If a woman has a normal pet butis persistently positive for
HPV strains, I definitelyrecommend they get a colposcopy,
which is a microscopic view ofthe cervix, to allow for direct
(45:07):
observation of the cervix forexamination and biopsy of any
suspicious areas.
This procedure can take placein the doctor's office.
In 2006, gardasil was the firstcervical cancer vaccine, which
affects four strains of HPV andit's offered to girls ages 9 and
(45:30):
older up to the age of 26.
And there's a series of threeinjections over six months and
has recently been extended tomales and females up to the age
of 45.
The immunization is generallycompleted within six months
prior to sexual activity.
But even if you've had the HPVvaccine, even if your partner's
(46:00):
had it, you still need regulargynecologic exams and periodic
pap smears.
And HPV has been associatedwith other cancers, such as
throat cancer, anal cancer, lungcancer, penile cancer and
possibly even some forms ofbreast cancer.
And it was first approved forfemales in the United States,
but later was extended to malesas well.
So, on the record, maintainingyour own file my final
(46:24):
suggestion on making the most ofyour physician visit is to give
you an assignment.
A great way to stay in chargeof your own health is to keep
your own detailed medical fileat home, just like you maintain
financial records or details onwhen your car was last serviced.
Please, please, keep your ownmedical file.
And if you don't have yourfiles on hand, you're like most
(46:50):
patients, even doctors andnurses, who don't have their
cholesterol level.
They don't know how many unitsof vitamin D they're taking,
whether they had one or bothovaries removed, whether they
had a full hysterectomy or not,and this information is vitally
important, especially if youswitch physicians, move to a new
city, and while we havetechnology and online medical
records, we all have to takeresponsibility for keeping hard
(47:14):
copies of medical records,particularly surgical reports,
pathology reports, and I thinkit's good for you to be involved
in keeping track of yourmarkers of health.
And you never know whenthere'll be issues with
networking, computer viruses orthe transmission between
different health systems, somaybe some of these practices
(47:37):
are already a habit for you.
A lot of women weigh themselvesonce a week.
They know when they're going toget their menstrual period.
Some people write it down on acalendar or track it on an app.
So why should you bother tokeep a health file?
Well, weight and height candetermine your body mass index,
which can be a factor indetermining your risk for
certain conditions like heartdisease and diabetes.
(48:00):
Even if you're not worriedabout pregnancy, knowing the
dates of your past menstrualcycle can help you and your
health care clinician determinewhether you've started into
perimenopause.
Designate a special file whereyou can keep your records.
Pick out a pink folder, make ithot pink or something that
stands out and listed below isthe information you should
(48:22):
collect.
Keep it handy Don't stick itbehind other files or in the
bottom of a drawer and bringyour folder with you when you
see your physician.
Take the time before theappointment to review your
latest records and be sure tonote questions and concerns you
have.
Bring in medications,supplements with you.
Pictures are not nearly ashelpful because you can't see
(48:44):
everything on the bottle the lotnumber, the expiration date.
Keeping track of your recordsallows you and your physician to
plan the optimum course ofprevention and treatment
together.
Well, what should I put in myfile?
I suggest you compile importantstatistics that you keep at
hand.
Weigh yourself once a week andlist that.
(49:05):
We all know that scale will tipafter an indulgent weekend or
during a certain time of themonth.
Even throughout the day, ourweight can fluctuate several
pounds during the week.
So weigh yourself in themorning and please don't let the
numbers determine your mood oryour dinner plans.
Why is weight important?
Well, the higher your BMI,generally speaking, the higher
(49:27):
disease risk, cholesterol, bloodpressure and diabetes risk.
Also, it can make arthritisworse.
It can contribute toobstructive sleep apnea,
gallbladder disease and severalcancers.
Ultimately, weight gain canaffect the quality of life,
including the way you feel andlook each day.
Height Unfortunately, most of usdo shrink with age and height,
(49:49):
but not in weight.
How many inches we lose can bea sign of our skeletal bone
health.
Weak bones of lower bonedensity eventually translate
into osteoporosis or morefull-fledged bone loss.
That can result in painfulfractures, which can curtail
lifestyle and even lead to deathor nursing home placement.
So get in the habit ofmeasuring yourself, at least
(50:12):
yearly, and generally we do itin the morning, because you tend
to be taller in the morning andlosing for a woman up to 1.5
inches of height can be normaljust from losing some of the
disc space.
Bmi, body mass index.
Unfortunately, we women aremore prone to weight gain than
men because female hormones athigher doses can promote the
(50:35):
female fat deposition, becausewe are the sex that carries
children.
What's more is muscle mass islost, especially after age 40,
in a process known as sarcopenia, and it can be replaced with
body fat.
So the older we get, the harderwe have to work to keep off the
fat because our metabolismslows down.
(50:56):
Bmi is a reliable indicator ofbody fat in many women not all.
Certainly athletes, males,people that have very dense
bones and high musculature canhave a high BMI, but in general,
for most people it's a veryhelpful calculation.
(51:18):
To calculate your BMI.
Take your weight in pounds anddivide your height squared and
multiply by 703.
So if you're a woman who's 5'5and you weigh 155 pounds, you
divide the weight by the heightsquared and you get your BMI,
which is 26, which is borderlineIn general.
(51:40):
If your BMI is less than 18.5,you're underweight.
If you're 18.5 to up to 25,you're normal.
18.5 to up to 25, you're normal.
Once you're 25 to 27, you're inthat borderline category.
Over 27 to 29.9, bmi isoverweight and 30 and over is
(52:05):
obese.
So this mythical woman who'sfive foot five and 155 pounds is
not overweight, but she's kindof teetering and it might be
important to focus on healthyeating, maybe some intermittent
fasting, maybe focusing more onweightlifting to build muscle or
maintain muscle as opposed tothe aerobic activity which can
increase appetite.
But BMI does have limits.
(52:26):
Athletes, individuals that arevery muscular, will have a high
BMI.
My three sons are all athletesand they all have BMIs of 30,
which would be considered obese,and yet they have probably 11%
or less of body fat because youcan see their muscles.
So it's not for everyone.
(52:47):
Following trends and patternsare important.
Sometimes we do body fatanalysis by submerging in water
to calculate a fat percentage.
Our bone density machine canalso calculate lean body mass
and total body fat.
Sometimes we do this when womendon't have enough body fat and
(53:10):
therefore they can't maintainmenstruation and fertility.
So know your family history.
You can't choose your genes,but you can take steps to
mitigate your risk of cancerdiseases and other medical
conditions that run in yourfamily.
If your mother had breastcancer, your risk of getting it
is greater than a woman withouta family history.
(53:30):
It also helps if you knowthings like the age your mother
was when she entered menopause.
Did your grandmother have abroken hip from osteoporosis?
Or maybe it was just a hipreplacement because she had
osteoarthritis a differentcondition.
So the more you know, the moreyou can help control your future
health.
(53:51):
Vitamins, supplements andprescriptive medicines Know
exactly what you're taking andbring those bottles in.
Many women don't mention herbalremedies or non-prescription
treatments, but you should,because they can have
significant impact onmedications, health conditions
and even the effects ofanesthesia if you're having
surgery.
So please speak up about these.
(54:16):
Fasting lipid levels.
Cholesterol ratios can changebefore and right after menopause
.
The same goes for bloodpressure.
Knowing your cholesterol isimportant to identify risk for
heart disease, diabetes andstroke your physician can give
you a referral to a laboratoryto test your lipids Blood
pressure.
The guideline for women is about115 over 75, and many of my
(54:36):
patients exceed this.
I recommend checking your bloodpressure in the morning, as it
tends to be a bit higher.
Wait at least 30 minutes afterhaving coffee or caffeine.
Check your blood pressure underdifferent circumstances, such
(54:57):
as when you're relaxed or 30minutes after exercise or when
you're feeling anxious or tense.
If you continue to log highblood pressure readings, do not
wait for an annual checkup to dosomething about it.
What does my blood pressurereading actually mean?
Well, a healthy heart beats ina predictable cycle and it
contracts and relaxes, so youget a systolic and a diastolic
level.
Some people have elevations ofboth.
(55:19):
In either case, it's veryimportant to control high blood
pressure and it's important tonot make excuses like well, you
know I'm stressed or I don'tlike seeing the doctor, so there
can be other complaints thatpeople have.
But if it's elevated it canlead to stroke, heart failure,
(55:40):
kidney failure, hemorrhages inthe blood vessel or peripheral
vascular disease.
If your blood pressure is 120over 80, that's not normal,
that's prehypertension.
So shoot for 115 over 75 orless.
Please keep results of testssuch as your last bone density.
Many insurances will only coverit every 24 months.
(56:02):
When was your most recentmammogram?
Many insurances require it tobe 366 days from the last
mammogram.
Do you have your blood levelresults?
Other records?
What screenings have you hadfor cancer?
Do you have a durable power ofattorney and advanced health
(56:24):
care directives.
And so you're ready to roll.
Now you know what you need todo to find a doctor, what
questions to answer, what teststhat you need, what to expect
and how to keep track of yourhealth information.
So you have the knowledge andthe tools and you're ready to be
(56:47):
a full partner in your healthcare.
So you have been in theSunflower House with your host
and author, Dr Holly Thacker.
Thanks so much for joining us.
Please subscribe to our podcaston any of the channels and give
us a rating, and please be sureto join me back in the
(57:08):
Sunflower for chapter twosymptoms of menopause.
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