December 10, 2025 • 31 mins
Hot flashes don’t keep a schedule, and neither do lab numbers. We sit down with Dr. Rachel Novik of Cleveland Clinic’s Center for Specialized Women’s Health to cut through the noise around perimenopause, menopause, and hormone testing—and focus on what actually helps you feel like yourself again.
We talk about why the most reliable “diagnosis” of menopause is still 12 months without a period, and when lab work like estradiol and FSH can be helpful for patients with hormonal IUDs or after hysterectomy. She breaks down common myths about the Dutch test and other urine hormone panels, explains why major medical societies don’t endorse them for menopause, and shows how chasing unvalidated numbers can drive unnecessary supplements and costs without improving outcomes.
If you’re overwhelmed by conflicting advice on “balancing hormones,” this episode offers a calmer path: collaborate with a clinician, align on goals, and judge success by how you feel, not a single number.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Leigh Klekar (00:01):
Welcome to the Speaking of Women's Health
podcast.
I'm your guest host today, LeeClecker.
I am the producer, producer ofthe Speaking of Women's Health
podcast, and I'm so happy to beback in the Sunflower House.
Today I am being joined by Dr.
Rachel Novick.
She is a newly appointedphysician at Cleveland Clinic
(00:23):
Center for Specialized Women'sHealth, and we'll be talking
about her new role, her areas ofspecialty, and we'll dive into
some important women's healthtopics, especially around
perimenopause, menopause, andhormone testing.
But first, let me tell you alittle bit about Dr.
Novick.
She's a board-certified familymedicine physician.
(00:47):
She recently completed thespecialized women's health
fellowship at Cleveland Clinicunder Dr.
Thacker.
And congratulations, Dr.
Novick, on that.
A lot of hard work, many years.
And for our loyal followers,I'm sure you saw many of the
pictures we posted on socialmedia with all the graduation
(01:07):
pictures of her and Dr.
Cohn.
And her academic journey beganat New York University, where
she earned a bachelor's degreein social work with a minor in
child and adolescent mentalhealth.
She went on to complete herpre-medical sciences at John
Carroll University here inNortheast Ohio, followed by
(01:29):
medical school at OhioUniversity's Heritage College of
Osteopathic Medicine.
And Dr.
Novick completed her residencyin family medicine at University
Hospital's St.
John Medical Center, where sheserved as chief resident and
helped develop a women's healthcurriculum.
She brings a deep passion forcaring for women across all
(01:52):
stages of life with a specialfocus on those in their middle
and later decades where caregaps often exist.
And this is not Dr.
Novick's first time on thepodcast.
She joined Dr.
Thacker in season one.
So without further ado, welcomeDr.
Novick.
You're welcome.
(02:13):
So let's start by introducingyour new role.
And can you tell our audiencewhat you'll be doing at
Cleveland Clinic?
Yeah, that's my side of town,so I like it.
(03:22):
So can you share a little bitmore about what your areas of
specialty are?
And you know, within the Centerfor Specialized Women's Health,
what are you most passionateabout focusing on as a
physician?
(04:29):
Absolutely.
And there's not enough of youout there right now.
So yeah.
So you mentioned that you'll beat main campus, um, and then
you'll be hopefully changingoffices.
So we can put that informationin the show notes for those of
our listeners who are inNortheast Ohio.
Um, and as soon as we know hernew locations, we'll get that
(04:53):
posted as well.
Um, so I want to kind of talkabout because you will be
specializing in, as wementioned, you know,
perimenopause and menopause alot and hormones and um birth
control, which doesn't alwayshave to be for actually
contraception, can be also justhormonal control.
Um, but so we heard from a lotof the nurses that work with you
(05:16):
in the Center for SpecializedWomen's Health that patients
often ask about blood tests todetermine if they're in
perimenopause or menopause, youknow, things like progesterone
levels, the Dutch test, andother urine hormone panels.
So there's a lot of talk aboutalso this.
I don't, I've never heard this,but blood being the gold
(05:38):
standard.
Um, so I want to unpack that abit.
And um, first let's start withare there any blood tests that
are actually recommended?
And then what those labs um arethat aren't necessary for
actually diagnosing menopause.
Dr. Rachel Novik (05:55):
The answer is are there necessary for
diagnosing menopause?
The answer is no.
Because the true diagnosis ofmenopause is 12 months or 10
period.
So I don't need any of thoselabs to tell you, hey, you
haven't had a period in 12months.
Yeah, you meet thequalification, you meet that
cutoff guideline.
But there are lab tests that Iwill check just to kind of get a
(06:19):
baseline idea of where you are,and they can be more helpful in
specific populations, such asum people who have an IUD, a
hormonal IUD, and aren't gettinga period.
Or someone who has ahysterectomy, so we just don't
know what's going on.
Um, so that's when those labscan be a little more helpful.
That being said, I understandthat a lot of people like to
(06:42):
know that information.
So I don't think it'sunreasonable to say, if you, you
know, if we want those labs, wecan check them, and but know
that this is only one moment intime.
And if you're truly pre-orper,those levels are going to change
moment to moment, moment tomoment, day to day, month to
month, week to week, etc.
So it's it gives you thissnapshot that is not necessarily
(07:07):
indicative of what the truepicture is.
So that is why we make thesediagnoses more so based on the
clinical picture as opposed toblood tests.
And that's why we base ourtreatment and its effectiveness
on how you feel and not on ablood test.
Leigh Klekar (07:24):
So that's a lot of questions about the symptoms,
right?
Speaker (07:28):
Yeah.
Leigh Klekar (07:28):
Um, and yeah, so I would imagine that you would
probably tell your a lot of yourpatients to come prepared to
their appointments with you witha list of their symptoms.
And if they're not in menopauseyet, right, when their last
cycle was and how long and howheavy.
Dr. Rachel Novik (07:44):
And exactly.
Yeah, knowing your menstrualhistory, at least for the last
few cycles, is very helpfulbecause if you're someone that's
having a monthly period, I amnot necessarily going to make
the same recommendation assomeone who's having a period
every three, four months.
It it just changes what I mightthink about from a what is the
(08:07):
best option for you.
And that's why manopausehormone therapy isn't
necessarily one size fits all.
And we have to think abouthormone therapy and the options
as hormone therapy as opposed tobirth control or contraception.
It's all at the end of the day,the goal is to get you back to
a better steady state from ahormone standpoint.
Leigh Klekar (08:31):
Yeah, that's great.
So, can you talk about these?
So I mentioned the progesteronelevels, the Dutch test, um,
hormone panels, and the goldstandard.
So are those things that weshould know about?
Um, because you know, I'veworked very closely with, you
know, your team and Dr.
Thacker for many, many years.
(08:52):
And I haven't even heard ofthese before from the experts.
So Yeah, yeah.
Dr. Rachel Novik (08:56):
So the Dutch test.
The Dutch test is a urine testthat measures steroid, hormone,
and metabolites.
So this is cortisol, cortisone,estrogen, progesterone,
testosterone, DHEA.
A lot of the things that wethink about, but it's marketed
for evaluating hormone balanceand adrenal function and
menopause symptoms.
The problem with this test isthat it lacks independent
(09:18):
verification, and there islimited peer review research
regarding the Dutch test resultscompared to like gold standard
testing, which would be serum,um, blood, labs, um, or 24-hour
urine collection, salivaryassays.
So things that are justcollected slightly different.
Um, these the Dutch test teststends to do um, it depends on
(09:42):
which test people do.
So the Dutch test is the commonone, but there's a couple other
urine hormone testing thingswhere you will collect like a
daily sample of your urine umover the course of a month and
send that in, send them in.
And while it it again, it givesyou this snapshot in time, but
it still doesn't, it doesn'tgive you the true, you know, any
(10:06):
true data beyond what wealready know based on what your
body's doing.
Yeah.
Um, so the menopause society,ACOG, the endocrine society, and
all these major medical bodiesdo not include the Dutch test in
their guidelines for menopause,CCOS, infertility, adrenal
disorders, anything like that.
And that's because our hormonemetabolites in dried urine don't
(10:27):
necessarily reflect thereal-time hormone activity in
the body.
So our hormone levels willfluctuate throughout the day,
throughout our menstrual cycle,and with stress, sleep, diet
changes, medication changes.
So a single test snapshot ishard to interpret no matter
what.
But then when we're looking ina urine sample, it's even
(10:48):
further harder to reallynavigate how accurate this is
and difficult forinterpretation.
So I mentioned, you know, thatwhen I collect the blood work,
the results can always be, youknow, slightly misleading and
they can lead to unnecessarysupplements, hormones, treatment
(11:11):
options, you know, and and atthe end of the day, money spent
for something you don't need.
Leigh Klekar (11:15):
Right.
Dr. Rachel Novik (11:16):
Um, but like I said, I will check some blood
levels.
And the main levels I do lookat are estrogen or estradiol,
the FSH, which is your folliclestimulating hormone.
And this is one of multiplelabs that is that um assesses
ovarian function.
But this is the one that welook at specifically when we're
just kind of getting that broadpicture.
(11:37):
I tend to check a TSH or athyroid stimulating hormone.
And if someone has a history ofthyroid disease, I will also
add in a free T3 or T4,depending on the history of
their thyroid disease and ifthey're on medication.
So that looks a little closerat not just a screening thyroid,
but are you getting adequateadditional thyroid hormone if
(11:59):
you're taking a supplement?
Um, I check B12, vitamin D,ferritin, which is an iron
storage level.
And I also check a zinc becausethese are all deficiencies that
can lead to low energy, brainfog, fatigue, the same symptoms
we all complain of hot flashes,night sweats with the thyroids.
It's not good medicine, andit's not a good practice to
(12:21):
blame everything on hormoneswhen there could be a medical
reason for why you're or analternative reason as to why
you're having these symptoms.
Leigh Klekar (12:32):
Right.
Dr. Rachel Novik (12:32):
Um so yeah, and so I yeah.
Leigh Klekar (12:35):
Oh no, I was just gonna ask, you know, and I'm
kind of um do this at home justbecause I've been avoiding going
to, you know, getting myappointment, but I'm like, I'll
just take a zinc supplement andI'm just gonna take a omega-3
supplement, and I'm just gonnatake my calcium and my vitamin D
three and then my magnesium.
But so really, I mean, I don'tknow if I'm low in those.
(12:58):
I could be getting plenty ofthose, you know, from my diet
and the sun with vitamin D.
So really, I mean, it'sprobably best to don't do what I
do and to see your see your seean expert um because it could
be more than just hormones ordeficiency, it could be
something else too that'scausing.
Dr. Rachel Novik (13:19):
Right, exactly.
And with some supplements andsome vitamins, you don't want to
overdo it because these canlead to calcifications, they can
lead to arrhythmias.
They so you know, we're carefulwith the things that we
prescribe and and the doses werecommend.
Um, there's also issues when itcomes to are you taking an
adequate dose for optimalabsorption?
(13:40):
So there's there's more to itthan just like, should we take
one thing here, take one thingthere?
You know, it's we think aboutit a little bit.
Um, but you also mentioned likeomega fatty acids.
So those I know Dr.
Shacker has talked about them,but you know, those can affect
your mood and inflammation.
So it's just, yeah, you'reright.
That's one more thing that Ido, I do check on occasion, not
(14:00):
as consistently.
Um, and at the end of the day,with all of these supplements, I
would rather you get thesethings from your diet than from
a supplement.
Because when you're gettingthings from your diet, if
possible, um, you know, you'regetting additional nutrients
that are aiding in absorptionand your body's really
regulating that.
As opposed to a supplement,we're we're kind of just
(14:21):
throwing a larger dose at youand and absorb and you know,
you're absorbing however muchyou're absorbing out of.
Leigh Klekar (14:28):
Right, right.
Good point.
It's just the supplements arejust such a big trend, right?
And it's everywhere.
And yes, and you know, I Iwrite the headlines for the
social media for speaking ofwomen's health.
So I'm on a lot of social mediaand it's just it's everywhere.
And and and sometimes I'm like,okay, that's what we're saying,
and that's correct because Iwork with you know physicians,
(14:51):
and then sometimes like that'sjust so not correct, but women
are reading this, and so it'sjust scary.
There's so much.
Dr. Rachel Novik (14:56):
And I like it would be a lie to say we don't
all fall into those marketingschemes from time to time,
right?
Like, I've definitely bought avitamin that I'm like, oh, let
me try this, let me see if Ifeel any better.
And then I'm like, Well, Idon't know why I spent extra
money on this.
This is the same thing as thetarget brand, you know,
multivitamin I was takingbefore.
Yeah.
And it's, you know, but it's 10times the price.
Leigh Klekar (15:20):
Yeah, right.
Okay, so we took we we answeredthis, but I just want to sort
of actually get this down by.
So is it even possible to testfor perimenopause or menopause?
Dr. Rachel Novik (15:32):
Yes.
So uh yes and no.
So we have these serum bloodtests that give us an idea of
where you are in this transitionperiod, right?
So your FSH can help usdetermine what your ovaries are
doing.
And the ovaries are where weget are getting a majority of
our estrogen from.
So if that FSH is high, ideallyI like to see a level of at
(15:53):
least 35, but um, or a level of35, but at least over 25, that
can give us an idea ofperimenopause or menopause.
But then we compare we add thisinto an estrogen level.
So if you have an estrogenlevel that's undetectable, or
within our Cleveland Clinic lab,it's less than 25, then we're
thinking, okay, your ovaries aregetting, you know, sending out
(16:15):
this signal.
We need, we, we need to betrying to make, you know,
ovulate and have these eggs umpushed out to, you know, get
pregnant, etc.
And our estrogen level issaying we got nothing.
So that picture, that balanceof your estrogen level and your
ovarian function come togetherto tell us like, are you more
(16:36):
likely on one side of this, youknow, this transition period
versus the other?
So if you have a high FSH and alow estrogen level, you're more
likely to be in thatperimenopause-menopause stage.
But let's say you have a lowFSH and a high estrogen level,
that tells us your ovaries aredoing what they should be doing
(16:57):
from a pre-perimenopausestandpoint, they're ovulating.
And your estrogen level isshowing that this is happening
because it's nice and high.
Your body's getting what it'sneed, what it needs.
But when that, when it's notthose two clear pictures, when
it's a high estrogen and a highFSH, it's like, okay, at some
(17:17):
point you had some ovulation,your body's clearly making some
estrogen, you're inperimenopause.
Or if both are low, then I'mlike, okay, your ovaries are
still telling me that they'redoing something because there's
still function going on, andthis feedback signal is still
where where I expect it to be,but your estrogen's low.
So depending on where you arein your cycle, that could just
(17:39):
again be that one moment intime, or it's telling us, yeah,
you, you know, things are right,but maybe you missed the cycle
this time.
Leigh Klekar (17:48):
Yeah.
Wow, that's interesting.
I actually, I mean, I've done alot of these interviews and
listened to a lot of them, butyou know, you explained that
really well.
Um, so thank you.
Uh, can you walk us throughwhich blood tests or labs should
not be used to determine if awoman is in menopause?
Yes.
Dr. Rachel Novik (18:09):
So, as I've said a couple of times, estrogen
and FSH are the only two liketrue labs that I order when I'm
like, let's see where you are inthe scheme of things.
I don't typically orderprogesterone, I don't order LH,
which is another um ovarianfunction level, and I don't
order an AMH level, which cankind of tell us egg reserve
levels.
(18:29):
Um and I don't order thosebecause number one, they don't
necessarily change anything Ido, but they cost you more
money.
Number two, the specificallythe AMH, you know, the only time
we ever really order it is whenwe're thinking about egg
retrieval and IVF and those, youknow, that side.
(18:51):
And are you gonna be a goodcandidate for stimulation so we
can get those eggs?
So it's not something that Ireally I use even in just kind
of a screening situation.
But at the end of the day, yourlabs can tell us, like we've
talked about, they can tell uswhatever they want.
If you're having a monthlycycle, I'm not gonna consider
you menopause.
Sure, we can put the label oflike perimenopause, but that's
(19:14):
you know, that's because you'rehaving symptoms.
Is it truly perimenopause, TMS?
It's hard to know.
It's such a gray area.
Leigh Klekar (19:22):
Yeah.
Dr. Rachel Novik (19:23):
But it it can be, you know, it can be nice to
have a little more data and alittle more information.
I think we're such adata-driven society and
population that we like to havethose numbers, but we have to
remember that not everything isnumber driven.
Leigh Klekar (19:37):
Right.
Because everyone's symptoms areso different.
But like you mentioned, itwould be nice to just kind of
know what is actually happeningwith my body and what will make
me feel better.
Well, what will make me feelmore like myself, or so, you
know, it's I think it's justthat like you you mentioned, we
like we get a lot of data, youknow, headlines, but it's just
(19:58):
nice to know what's going on andget an answer.
Dr. Rachel Novik (20:01):
Exactly.
But I also, you know, I thinkthe one the one thing I run into
more these days, especially aswomen are coming in with regular
cycles and they'reperimenopause.
You're having a regular cycle,but you're having symptoms.
Trying to get someone on boardwith like a birth control pill,
because a birth control pillsuppresses ovulation, right?
(20:24):
So when you're when you'rehaving a monthly period, you're
going up and down and up anddown and up and down, and these
estrogen, progesterone, andother hormone fluctuations are
what are triggering your periodevery month.
So when you're having symptomsand you're fluctuating, but
those fluctuations and thosekind of erratic fluctuations and
severe fluctuations are whatcause a lot of these symptoms.
(20:45):
One of the most effectivethings we can do is suppress
ovulation.
So you're no longer going upand down, you're just going nice
and steady.
And then we give you estrogenin that birth control pill.
And so you have a nice estrogenlevel because we're still
giving it to you.
But I think we get stuck onit's a birth control pill.
(21:05):
But in this situation, it'struly hormone replacement
therapy because we're stillgiving you or replacing what
your body would otherwise bedoing, controlling that
fluctuation.
So that's why there's so much,you know, it is a very
individualized approach.
And and it's also acollaborative approach.
(21:27):
So if you don't like what yourphysician or your clinician is
recommending, you have to havethat conversation.
Um, but it's not necessarilythat we're just saying, oh,
here's a pill, take it.
There's a reason behind it, youknow?
Leigh Klekar (21:42):
Well, and yeah, and I think like you mentioned,
a lot of women just think, okay,I did that, you know, we're I'm
past the childbearing ages.
I or, you know, and I took thatbirth control for so many years
and had to remember to takethat pill.
I think they're just like, oh,really, I've got to go back to
that again.
Maybe some of them, right?
Right, exactly.
Dr. Rachel Novik (21:58):
Exactly.
Feel that way.
You know, my my other argumentis like at the end of the day,
it's often one pill versusanother pill.
And they tend to be at leastone pill once a day.
And one's typically zerodollars by your insurance,
another one ranges in price.
So there's not like sometimesthe right answer is what is the
(22:21):
most effective, cost-effectivething too.
Leigh Klekar (22:23):
Yeah, very right.
And if you're spending hundredsof dollars on supplements, I
mean, and you know, right.
So right, exactly.
Like, I just think I, you know,I I think again, it's just
getting over that, you know, WHIstudy and and and a little bit
of that as well, right?
That we need to reassure ourpatients that it's okay.
Dr. Rachel Novik (22:42):
And it's it's the marketing, just like we keep
talking about this, like, oh,we need to balance our hormones.
And it's not, you know, it'snot, I guess it is a balance in
some ways, but it's maybe not,there's no like perfect answer
to this.
It's it's a especially withperimenopause, it's like this is
when it becomes an art, andwe're doing these like small
(23:04):
changes just to find the rightregimen for you.
Yes.
Um, and when we get thrown,take this test to to optimize
yourself, and then take thissupplement that's like cortisol
balance, and then take thisother thing for your thyroid.
You know, it's like it gets tobe very confusing, and a lot of
those supplements can affectyour lab values on blood work,
(23:26):
they can affect your liver andyour kidney function.
You know, they nothing we do iswithout side effect, right?
So that's why I always say likeyou're better off seeing
someone who works, I you know,is a f you know, registered
licensed physician or clinician.
And we always prefer thoseFDA-approved prescription
(23:48):
medications as opposed to thesecompounded things that you don't
necessarily get that same likedose and pump to pump of the
cream or click to click,whatever it is, because we know
you're getting this nice steadystate.
Leigh Klekar (24:00):
Yes.
And I mean, I think this hasbeen said before on the podcast,
but just do your research toobefore you see a physician.
Um, my dear friend, um, I'verecommended all of you to her,
but she just has, you know, sheneeds to get in quick.
So she saw someone else whosaid, No, I don't, I don't want
to prescribe hormone therapy.
(24:21):
And that's why she was goingthere.
So, you know, it was basicallya waste of a well visit for her
and um really frustrating.
And I said, Don't go, don't seeher again.
And I may, you know, so that'sjust sort of like maybe see what
you can find out about thephysician before you see them.
Because if you're going therefor, you know, hormone therapy,
birth control, and they're notgoing to prescribe it or try and
(24:43):
talk you out of it, then thatmay not be the physician for
you.
Dr. Rachel Novik (24:47):
Right, for sure.
And and it's, you know, it'shard because there aren't a lot
of physicians and clinicians outthere that are comfortable with
prescribing.
And we're, you know, we're outthere, we're educating people,
we're we're doing all sorts ofthings at the clinic to help get
our primary care docs and ourresidents and our, you know, all
(25:08):
sorts of people kind of onboard with hormones.
But that doesn't mean thatthey're comfortable at the end
of the day.
They might be open to it, butthat's why, you know, that's why
you see someone that that istruly a specialist.
Leigh Klekar (25:20):
Yes.
Yeah.
Okay.
So we talked about this alittle bit, but are there any
other blood tests or labs thatum you want to mention or that
you want patients to steer awayfrom?
Um, any other sort of warnings?
Dr. Rachel Novik (25:36):
Um, you know, at the end of the day, I think
you can come in with whateverlabs you want.
Um, I've lately been getting alot of questions about like a
sex hormone binding globulinlevel.
So I I generally say, you know,this level goes up as we go, as
we age and as we go throughmenopause.
And again, we don't treatnumbers.
(25:57):
We treat based on how you feel.
So we don't, I don't order labsroutinely because I don't want
to, I don't want people to getso focused on that.
I want you to feel good.
I want you to feel so good thatyou're not even thinking about
it that you're like, I don'tneed a I don't need a level.
I want, I just feel good.
You know, it's when when we getfocused on numbers, that's when
(26:18):
that's when things kind of getlost in the process, right?
Um, obviously, if you're havingissues, if you're having
bleeding, if you're havingcramping, things like that, then
I think about do we need tocheck your level?
Is there an imbalance in thissituation where you have too
much estrogen or too muchtragesterone?
And we need to we need toassess that and make sure that
(26:40):
there's nothing else going on.
But unless there's a problem, Idon't necessarily need to check
labs.
Um, I will, though, especiallyif I, you know, if I start you
on a regimen and you're like, Ifeel good, but maybe I'm having
a little breakthrough symptom,or maybe I've been on this
regimen for a couple months, ayear, and all of a sudden
(27:01):
something just feels a littledifferent.
So then we're thinking, like,is your patch in the right
place?
Are you changing it?
Are you, you know, of the rightinterval, whether it's three
and a half days versus once aweek?
Do we need to switch it basedon placement?
Do we need to switch from aonce a week to a twice a week?
Do we need to switch you from apill to a patch?
You know, there's all sorts ofthoughts that go into it there.
(27:23):
And so that's when I find thatthose levels can be a little
more helpful because then I'mgonna say, okay, well, maybe
you're not absorbing it as well.
Leigh Klekar (27:31):
Great.
So before we wrap up, do youhave any other final thoughts or
tips that you'd like to sharewith our listeners?
Dr. Rachel Novik (27:40):
Um, I think we've touched on a lot of it
just through conversation, butyou know, I think just
remembering menopause andespecially perimenopause can be
difficult to manage.
And it's it's an art at somepoint, more than a science.
And you know, listen to yourclinicians.
And if you don't understand whya regimen is being recommended,
(28:00):
ask.
Because if you don't ask, thenyou don't understand, right?
So I think at the end of theday, if we can understand why
something's being recommended tous, we're more likely to get on
board with it.
Um and then we're all on thesame page and we can work
together to better find whatthat right regimen is for you if
(28:22):
you don't like whatever thatregimen is.
Um, and then, you know, I thinkthe other big thing is like
you've all heard this before ifyou listen to this podcast, that
we don't recommend pellotherapybecause you can have those
unregulated hormone levels.
Um, and we don't recommendtopical progesterone cream
because it doesn't absorb well.
So and and frankly, the youknow, the the last piece is I
(28:46):
don't recommend you create yourown hormone regimen, but if
you're if you're going to tryto, you know, work work with
your clinician, make sure youguys are on the same, you know,
on the same page and doing thattogether, because you that
balance between estrogen andprogesterone is a is a balance.
And too much of one thing,especially too much estrogen
with not enough progesterone,can have serious consequences.
(29:07):
So we don't, you know, we don'twant to put you at higher risk
if if we don't need to.
Leigh Klekar (29:14):
Right.
Thank you.
And then finally, how canpatients schedule an appointment
with you?
Dr. Rachel Novik (29:21):
Yeah, so I think there's a handful of ways
to schedule with our department.
You can call the Center forSpecialized Women's Health,
which is 216-444-6601.
You can call the ClevelandClinic for Her Women's Health
line, which is 216-4444 for her.
(29:43):
And then there's also theCleveland Clinic Comprehensive
Women Women's Health.
What is it?
Cleveland Clinic Women'sComprehensive Health and
Research Center, which is 4448686.
Leigh Klekar (29:59):
Great.
You and we'll put that in theshow notes too for our
listeners.
And you can actually find a lotof those phone numbers on
speakingofwomen's health.com.
Well, thank you, Dr.
Novik.
This has been great.
I appreciate you joining us onthe Speaking of Women's Health
podcast.
And thank you to our listenersfor tuning in to another episode
of the podcast.
(30:19):
We're very grateful for yoursupport and hope you will
consider supporting the podcastby sharing it with your friends
and family.
So thank you again forlistening, and we will see you
next time in the SunflowerHouse.
Be strong, be healthy, and bein charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your guest host today, LeeClecker.
I am the producer, producer ofthe Speaking of Women's Health
podcast, and I'm so happy to beback in the Sunflower House.
Today I am being joined by Dr.
Rachel Novick.
She is a newly appointedphysician at Cleveland Clinic
(00:23):
Center for Specialized Women'sHealth, and we'll be talking
about her new role, her areas ofspecialty, and we'll dive into
some important women's healthtopics, especially around
perimenopause, menopause, andhormone testing.
But first, let me tell you alittle bit about Dr.
Novick.
She's a board-certified familymedicine physician.
(00:47):
She recently completed thespecialized women's health
fellowship at Cleveland Clinicunder Dr.
Thacker.
And congratulations, Dr.
Novick, on that.
A lot of hard work, many years.
And for our loyal followers,I'm sure you saw many of the
pictures we posted on socialmedia with all the graduation
(01:07):
pictures of her and Dr.
Cohn.
And her academic journey beganat New York University, where
she earned a bachelor's degreein social work with a minor in
child and adolescent mentalhealth.
She went on to complete herpre-medical sciences at John
Carroll University here inNortheast Ohio, followed by
(01:29):
medical school at OhioUniversity's Heritage College of
Osteopathic Medicine.
And Dr.
Novick completed her residencyin family medicine at University
Hospital's St.
John Medical Center, where sheserved as chief resident and
helped develop a women's healthcurriculum.
She brings a deep passion forcaring for women across all
(01:52):
stages of life with a specialfocus on those in their middle
and later decades where caregaps often exist.
And this is not Dr.
Novick's first time on thepodcast.
She joined Dr.
Thacker in season one.
So without further ado, welcomeDr.
Novick.
You're welcome.
(02:13):
So let's start by introducingyour new role.
And can you tell our audiencewhat you'll be doing at
Cleveland Clinic?
Yeah, that's my side of town,so I like it.
(03:22):
So can you share a little bitmore about what your areas of
specialty are?
And you know, within the Centerfor Specialized Women's Health,
what are you most passionateabout focusing on as a
physician?
(04:29):
Absolutely.
And there's not enough of youout there right now.
So yeah.
So you mentioned that you'll beat main campus, um, and then
you'll be hopefully changingoffices.
So we can put that informationin the show notes for those of
our listeners who are inNortheast Ohio.
Um, and as soon as we know hernew locations, we'll get that
(04:53):
posted as well.
Um, so I want to kind of talkabout because you will be
specializing in, as wementioned, you know,
perimenopause and menopause alot and hormones and um birth
control, which doesn't alwayshave to be for actually
contraception, can be also justhormonal control.
Um, but so we heard from a lotof the nurses that work with you
(05:16):
in the Center for SpecializedWomen's Health that patients
often ask about blood tests todetermine if they're in
perimenopause or menopause, youknow, things like progesterone
levels, the Dutch test, andother urine hormone panels.
So there's a lot of talk aboutalso this.
I don't, I've never heard this,but blood being the gold
(05:38):
standard.
Um, so I want to unpack that abit.
And um, first let's start withare there any blood tests that
are actually recommended?
And then what those labs um arethat aren't necessary for
actually diagnosing menopause.
Dr. Rachel Novik (05:55):
The answer is are there necessary for
diagnosing menopause?
The answer is no.
Because the true diagnosis ofmenopause is 12 months or 10
period.
So I don't need any of thoselabs to tell you, hey, you
haven't had a period in 12months.
Yeah, you meet thequalification, you meet that
cutoff guideline.
But there are lab tests that Iwill check just to kind of get a
(06:19):
baseline idea of where you are,and they can be more helpful in
specific populations, such asum people who have an IUD, a
hormonal IUD, and aren't gettinga period.
Or someone who has ahysterectomy, so we just don't
know what's going on.
Um, so that's when those labscan be a little more helpful.
That being said, I understandthat a lot of people like to
(06:42):
know that information.
So I don't think it'sunreasonable to say, if you, you
know, if we want those labs, wecan check them, and but know
that this is only one moment intime.
And if you're truly pre-orper,those levels are going to change
moment to moment, moment tomoment, day to day, month to
month, week to week, etc.
So it's it gives you thissnapshot that is not necessarily
(07:07):
indicative of what the truepicture is.
So that is why we make thesediagnoses more so based on the
clinical picture as opposed toblood tests.
And that's why we base ourtreatment and its effectiveness
on how you feel and not on ablood test.
Leigh Klekar (07:24):
So that's a lot of questions about the symptoms,
right?
Speaker (07:28):
Yeah.
Leigh Klekar (07:28):
Um, and yeah, so I would imagine that you would
probably tell your a lot of yourpatients to come prepared to
their appointments with you witha list of their symptoms.
And if they're not in menopauseyet, right, when their last
cycle was and how long and howheavy.
Dr. Rachel Novik (07:44):
And exactly.
Yeah, knowing your menstrualhistory, at least for the last
few cycles, is very helpfulbecause if you're someone that's
having a monthly period, I amnot necessarily going to make
the same recommendation assomeone who's having a period
every three, four months.
It it just changes what I mightthink about from a what is the
(08:07):
best option for you.
And that's why manopausehormone therapy isn't
necessarily one size fits all.
And we have to think abouthormone therapy and the options
as hormone therapy as opposed tobirth control or contraception.
It's all at the end of the day,the goal is to get you back to
a better steady state from ahormone standpoint.
Leigh Klekar (08:31):
Yeah, that's great.
So, can you talk about these?
So I mentioned the progesteronelevels, the Dutch test, um,
hormone panels, and the goldstandard.
So are those things that weshould know about?
Um, because you know, I'veworked very closely with, you
know, your team and Dr.
Thacker for many, many years.
(08:52):
And I haven't even heard ofthese before from the experts.
So Yeah, yeah.
Dr. Rachel Novik (08:56):
So the Dutch test.
The Dutch test is a urine testthat measures steroid, hormone,
and metabolites.
So this is cortisol, cortisone,estrogen, progesterone,
testosterone, DHEA.
A lot of the things that wethink about, but it's marketed
for evaluating hormone balanceand adrenal function and
menopause symptoms.
The problem with this test isthat it lacks independent
(09:18):
verification, and there islimited peer review research
regarding the Dutch test resultscompared to like gold standard
testing, which would be serum,um, blood, labs, um, or 24-hour
urine collection, salivaryassays.
So things that are justcollected slightly different.
Um, these the Dutch test teststends to do um, it depends on
(09:42):
which test people do.
So the Dutch test is the commonone, but there's a couple other
urine hormone testing thingswhere you will collect like a
daily sample of your urine umover the course of a month and
send that in, send them in.
And while it it again, it givesyou this snapshot in time, but
it still doesn't, it doesn'tgive you the true, you know, any
(10:06):
true data beyond what wealready know based on what your
body's doing.
Yeah.
Um, so the menopause society,ACOG, the endocrine society, and
all these major medical bodiesdo not include the Dutch test in
their guidelines for menopause,CCOS, infertility, adrenal
disorders, anything like that.
And that's because our hormonemetabolites in dried urine don't
(10:27):
necessarily reflect thereal-time hormone activity in
the body.
So our hormone levels willfluctuate throughout the day,
throughout our menstrual cycle,and with stress, sleep, diet
changes, medication changes.
So a single test snapshot ishard to interpret no matter
what.
But then when we're looking ina urine sample, it's even
(10:48):
further harder to reallynavigate how accurate this is
and difficult forinterpretation.
So I mentioned, you know, thatwhen I collect the blood work,
the results can always be, youknow, slightly misleading and
they can lead to unnecessarysupplements, hormones, treatment
(11:11):
options, you know, and and atthe end of the day, money spent
for something you don't need.
Leigh Klekar (11:15):
Right.
Dr. Rachel Novik (11:16):
Um, but like I said, I will check some blood
levels.
And the main levels I do lookat are estrogen or estradiol,
the FSH, which is your folliclestimulating hormone.
And this is one of multiplelabs that is that um assesses
ovarian function.
But this is the one that welook at specifically when we're
just kind of getting that broadpicture.
(11:37):
I tend to check a TSH or athyroid stimulating hormone.
And if someone has a history ofthyroid disease, I will also
add in a free T3 or T4,depending on the history of
their thyroid disease and ifthey're on medication.
So that looks a little closerat not just a screening thyroid,
but are you getting adequateadditional thyroid hormone if
(11:59):
you're taking a supplement?
Um, I check B12, vitamin D,ferritin, which is an iron
storage level.
And I also check a zinc becausethese are all deficiencies that
can lead to low energy, brainfog, fatigue, the same symptoms
we all complain of hot flashes,night sweats with the thyroids.
It's not good medicine, andit's not a good practice to
(12:21):
blame everything on hormoneswhen there could be a medical
reason for why you're or analternative reason as to why
you're having these symptoms.
Leigh Klekar (12:32):
Right.
Dr. Rachel Novik (12:32):
Um so yeah, and so I yeah.
Leigh Klekar (12:35):
Oh no, I was just gonna ask, you know, and I'm
kind of um do this at home justbecause I've been avoiding going
to, you know, getting myappointment, but I'm like, I'll
just take a zinc supplement andI'm just gonna take a omega-3
supplement, and I'm just gonnatake my calcium and my vitamin D
three and then my magnesium.
But so really, I mean, I don'tknow if I'm low in those.
(12:58):
I could be getting plenty ofthose, you know, from my diet
and the sun with vitamin D.
So really, I mean, it'sprobably best to don't do what I
do and to see your see your seean expert um because it could
be more than just hormones ordeficiency, it could be
something else too that'scausing.
Dr. Rachel Novik (13:19):
Right, exactly.
And with some supplements andsome vitamins, you don't want to
overdo it because these canlead to calcifications, they can
lead to arrhythmias.
They so you know, we're carefulwith the things that we
prescribe and and the doses werecommend.
Um, there's also issues when itcomes to are you taking an
adequate dose for optimalabsorption?
(13:40):
So there's there's more to itthan just like, should we take
one thing here, take one thingthere?
You know, it's we think aboutit a little bit.
Um, but you also mentioned likeomega fatty acids.
So those I know Dr.
Shacker has talked about them,but you know, those can affect
your mood and inflammation.
So it's just, yeah, you'reright.
That's one more thing that Ido, I do check on occasion, not
(14:00):
as consistently.
Um, and at the end of the day,with all of these supplements, I
would rather you get thesethings from your diet than from
a supplement.
Because when you're gettingthings from your diet, if
possible, um, you know, you'regetting additional nutrients
that are aiding in absorptionand your body's really
regulating that.
As opposed to a supplement,we're we're kind of just
(14:21):
throwing a larger dose at youand and absorb and you know,
you're absorbing however muchyou're absorbing out of.
Leigh Klekar (14:28):
Right, right.
Good point.
It's just the supplements arejust such a big trend, right?
And it's everywhere.
And yes, and you know, I Iwrite the headlines for the
social media for speaking ofwomen's health.
So I'm on a lot of social mediaand it's just it's everywhere.
And and and sometimes I'm like,okay, that's what we're saying,
and that's correct because Iwork with you know physicians,
(14:51):
and then sometimes like that'sjust so not correct, but women
are reading this, and so it'sjust scary.
There's so much.
Dr. Rachel Novik (14:56):
And I like it would be a lie to say we don't
all fall into those marketingschemes from time to time,
right?
Like, I've definitely bought avitamin that I'm like, oh, let
me try this, let me see if Ifeel any better.
And then I'm like, Well, Idon't know why I spent extra
money on this.
This is the same thing as thetarget brand, you know,
multivitamin I was takingbefore.
Yeah.
And it's, you know, but it's 10times the price.
Leigh Klekar (15:20):
Yeah, right.
Okay, so we took we we answeredthis, but I just want to sort
of actually get this down by.
So is it even possible to testfor perimenopause or menopause?
Dr. Rachel Novik (15:32):
Yes.
So uh yes and no.
So we have these serum bloodtests that give us an idea of
where you are in this transitionperiod, right?
So your FSH can help usdetermine what your ovaries are
doing.
And the ovaries are where weget are getting a majority of
our estrogen from.
So if that FSH is high, ideallyI like to see a level of at
(15:53):
least 35, but um, or a level of35, but at least over 25, that
can give us an idea ofperimenopause or menopause.
But then we compare we add thisinto an estrogen level.
So if you have an estrogenlevel that's undetectable, or
within our Cleveland Clinic lab,it's less than 25, then we're
thinking, okay, your ovaries aregetting, you know, sending out
(16:15):
this signal.
We need, we, we need to betrying to make, you know,
ovulate and have these eggs umpushed out to, you know, get
pregnant, etc.
And our estrogen level issaying we got nothing.
So that picture, that balanceof your estrogen level and your
ovarian function come togetherto tell us like, are you more
(16:36):
likely on one side of this, youknow, this transition period
versus the other?
So if you have a high FSH and alow estrogen level, you're more
likely to be in thatperimenopause-menopause stage.
But let's say you have a lowFSH and a high estrogen level,
that tells us your ovaries aredoing what they should be doing
(16:57):
from a pre-perimenopausestandpoint, they're ovulating.
And your estrogen level isshowing that this is happening
because it's nice and high.
Your body's getting what it'sneed, what it needs.
But when that, when it's notthose two clear pictures, when
it's a high estrogen and a highFSH, it's like, okay, at some
(17:17):
point you had some ovulation,your body's clearly making some
estrogen, you're inperimenopause.
Or if both are low, then I'mlike, okay, your ovaries are
still telling me that they'redoing something because there's
still function going on, andthis feedback signal is still
where where I expect it to be,but your estrogen's low.
So depending on where you arein your cycle, that could just
(17:39):
again be that one moment intime, or it's telling us, yeah,
you, you know, things are right,but maybe you missed the cycle
this time.
Leigh Klekar (17:48):
Yeah.
Wow, that's interesting.
I actually, I mean, I've done alot of these interviews and
listened to a lot of them, butyou know, you explained that
really well.
Um, so thank you.
Uh, can you walk us throughwhich blood tests or labs should
not be used to determine if awoman is in menopause?
Yes.
Dr. Rachel Novik (18:09):
So, as I've said a couple of times, estrogen
and FSH are the only two liketrue labs that I order when I'm
like, let's see where you are inthe scheme of things.
I don't typically orderprogesterone, I don't order LH,
which is another um ovarianfunction level, and I don't
order an AMH level, which cankind of tell us egg reserve
levels.
(18:29):
Um and I don't order thosebecause number one, they don't
necessarily change anything Ido, but they cost you more
money.
Number two, the specificallythe AMH, you know, the only time
we ever really order it is whenwe're thinking about egg
retrieval and IVF and those, youknow, that side.
(18:51):
And are you gonna be a goodcandidate for stimulation so we
can get those eggs?
So it's not something that Ireally I use even in just kind
of a screening situation.
But at the end of the day, yourlabs can tell us, like we've
talked about, they can tell uswhatever they want.
If you're having a monthlycycle, I'm not gonna consider
you menopause.
Sure, we can put the label oflike perimenopause, but that's
(19:14):
you know, that's because you'rehaving symptoms.
Is it truly perimenopause, TMS?
It's hard to know.
It's such a gray area.
Leigh Klekar (19:22):
Yeah.
Dr. Rachel Novik (19:23):
But it it can be, you know, it can be nice to
have a little more data and alittle more information.
I think we're such adata-driven society and
population that we like to havethose numbers, but we have to
remember that not everything isnumber driven.
Leigh Klekar (19:37):
Right.
Because everyone's symptoms areso different.
But like you mentioned, itwould be nice to just kind of
know what is actually happeningwith my body and what will make
me feel better.
Well, what will make me feelmore like myself, or so, you
know, it's I think it's justthat like you you mentioned, we
like we get a lot of data, youknow, headlines, but it's just
(19:58):
nice to know what's going on andget an answer.
Dr. Rachel Novik (20:01):
Exactly.
But I also, you know, I thinkthe one the one thing I run into
more these days, especially aswomen are coming in with regular
cycles and they'reperimenopause.
You're having a regular cycle,but you're having symptoms.
Trying to get someone on boardwith like a birth control pill,
because a birth control pillsuppresses ovulation, right?
(20:24):
So when you're when you'rehaving a monthly period, you're
going up and down and up anddown and up and down, and these
estrogen, progesterone, andother hormone fluctuations are
what are triggering your periodevery month.
So when you're having symptomsand you're fluctuating, but
those fluctuations and thosekind of erratic fluctuations and
severe fluctuations are whatcause a lot of these symptoms.
(20:45):
One of the most effectivethings we can do is suppress
ovulation.
So you're no longer going upand down, you're just going nice
and steady.
And then we give you estrogenin that birth control pill.
And so you have a nice estrogenlevel because we're still
giving it to you.
But I think we get stuck onit's a birth control pill.
(21:05):
But in this situation, it'struly hormone replacement
therapy because we're stillgiving you or replacing what
your body would otherwise bedoing, controlling that
fluctuation.
So that's why there's so much,you know, it is a very
individualized approach.
And and it's also acollaborative approach.
(21:27):
So if you don't like what yourphysician or your clinician is
recommending, you have to havethat conversation.
Um, but it's not necessarilythat we're just saying, oh,
here's a pill, take it.
There's a reason behind it, youknow?
Leigh Klekar (21:42):
Well, and yeah, and I think like you mentioned,
a lot of women just think, okay,I did that, you know, we're I'm
past the childbearing ages.
I or, you know, and I took thatbirth control for so many years
and had to remember to takethat pill.
I think they're just like, oh,really, I've got to go back to
that again.
Maybe some of them, right?
Right, exactly.
Dr. Rachel Novik (21:58):
Exactly.
Feel that way.
You know, my my other argumentis like at the end of the day,
it's often one pill versusanother pill.
And they tend to be at leastone pill once a day.
And one's typically zerodollars by your insurance,
another one ranges in price.
So there's not like sometimesthe right answer is what is the
(22:21):
most effective, cost-effectivething too.
Leigh Klekar (22:23):
Yeah, very right.
And if you're spending hundredsof dollars on supplements, I
mean, and you know, right.
So right, exactly.
Like, I just think I, you know,I I think again, it's just
getting over that, you know, WHIstudy and and and a little bit
of that as well, right?
That we need to reassure ourpatients that it's okay.
Dr. Rachel Novik (22:42):
And it's it's the marketing, just like we keep
talking about this, like, oh,we need to balance our hormones.
And it's not, you know, it'snot, I guess it is a balance in
some ways, but it's maybe not,there's no like perfect answer
to this.
It's it's a especially withperimenopause, it's like this is
when it becomes an art, andwe're doing these like small
(23:04):
changes just to find the rightregimen for you.
Yes.
Um, and when we get thrown,take this test to to optimize
yourself, and then take thissupplement that's like cortisol
balance, and then take thisother thing for your thyroid.
You know, it's like it gets tobe very confusing, and a lot of
those supplements can affectyour lab values on blood work,
(23:26):
they can affect your liver andyour kidney function.
You know, they nothing we do iswithout side effect, right?
So that's why I always say likeyou're better off seeing
someone who works, I you know,is a f you know, registered
licensed physician or clinician.
And we always prefer thoseFDA-approved prescription
(23:48):
medications as opposed to thesecompounded things that you don't
necessarily get that same likedose and pump to pump of the
cream or click to click,whatever it is, because we know
you're getting this nice steadystate.
Leigh Klekar (24:00):
Yes.
And I mean, I think this hasbeen said before on the podcast,
but just do your research toobefore you see a physician.
Um, my dear friend, um, I'verecommended all of you to her,
but she just has, you know, sheneeds to get in quick.
So she saw someone else whosaid, No, I don't, I don't want
to prescribe hormone therapy.
(24:21):
And that's why she was goingthere.
So, you know, it was basicallya waste of a well visit for her
and um really frustrating.
And I said, Don't go, don't seeher again.
And I may, you know, so that'sjust sort of like maybe see what
you can find out about thephysician before you see them.
Because if you're going therefor, you know, hormone therapy,
birth control, and they're notgoing to prescribe it or try and
(24:43):
talk you out of it, then thatmay not be the physician for
you.
Dr. Rachel Novik (24:47):
Right, for sure.
And and it's, you know, it'shard because there aren't a lot
of physicians and clinicians outthere that are comfortable with
prescribing.
And we're, you know, we're outthere, we're educating people,
we're we're doing all sorts ofthings at the clinic to help get
our primary care docs and ourresidents and our, you know, all
(25:08):
sorts of people kind of onboard with hormones.
But that doesn't mean thatthey're comfortable at the end
of the day.
They might be open to it, butthat's why, you know, that's why
you see someone that that istruly a specialist.
Leigh Klekar (25:20):
Yes.
Yeah.
Okay.
So we talked about this alittle bit, but are there any
other blood tests or labs thatum you want to mention or that
you want patients to steer awayfrom?
Um, any other sort of warnings?
Dr. Rachel Novik (25:36):
Um, you know, at the end of the day, I think
you can come in with whateverlabs you want.
Um, I've lately been getting alot of questions about like a
sex hormone binding globulinlevel.
So I I generally say, you know,this level goes up as we go, as
we age and as we go throughmenopause.
And again, we don't treatnumbers.
(25:57):
We treat based on how you feel.
So we don't, I don't order labsroutinely because I don't want
to, I don't want people to getso focused on that.
I want you to feel good.
I want you to feel so good thatyou're not even thinking about
it that you're like, I don'tneed a I don't need a level.
I want, I just feel good.
You know, it's when when we getfocused on numbers, that's when
(26:18):
that's when things kind of getlost in the process, right?
Um, obviously, if you're havingissues, if you're having
bleeding, if you're havingcramping, things like that, then
I think about do we need tocheck your level?
Is there an imbalance in thissituation where you have too
much estrogen or too muchtragesterone?
And we need to we need toassess that and make sure that
(26:40):
there's nothing else going on.
But unless there's a problem, Idon't necessarily need to check
labs.
Um, I will, though, especiallyif I, you know, if I start you
on a regimen and you're like, Ifeel good, but maybe I'm having
a little breakthrough symptom,or maybe I've been on this
regimen for a couple months, ayear, and all of a sudden
(27:01):
something just feels a littledifferent.
So then we're thinking, like,is your patch in the right
place?
Are you changing it?
Are you, you know, of the rightinterval, whether it's three
and a half days versus once aweek?
Do we need to switch it basedon placement?
Do we need to switch from aonce a week to a twice a week?
Do we need to switch you from apill to a patch?
You know, there's all sorts ofthoughts that go into it there.
(27:23):
And so that's when I find thatthose levels can be a little
more helpful because then I'mgonna say, okay, well, maybe
you're not absorbing it as well.
Leigh Klekar (27:31):
Great.
So before we wrap up, do youhave any other final thoughts or
tips that you'd like to sharewith our listeners?
Dr. Rachel Novik (27:40):
Um, I think we've touched on a lot of it
just through conversation, butyou know, I think just
remembering menopause andespecially perimenopause can be
difficult to manage.
And it's it's an art at somepoint, more than a science.
And you know, listen to yourclinicians.
And if you don't understand whya regimen is being recommended,
(28:00):
ask.
Because if you don't ask, thenyou don't understand, right?
So I think at the end of theday, if we can understand why
something's being recommended tous, we're more likely to get on
board with it.
Um and then we're all on thesame page and we can work
together to better find whatthat right regimen is for you if
(28:22):
you don't like whatever thatregimen is.
Um, and then, you know, I thinkthe other big thing is like
you've all heard this before ifyou listen to this podcast, that
we don't recommend pellotherapybecause you can have those
unregulated hormone levels.
Um, and we don't recommendtopical progesterone cream
because it doesn't absorb well.
So and and frankly, the youknow, the the last piece is I
(28:46):
don't recommend you create yourown hormone regimen, but if
you're if you're going to tryto, you know, work work with
your clinician, make sure youguys are on the same, you know,
on the same page and doing thattogether, because you that
balance between estrogen andprogesterone is a is a balance.
And too much of one thing,especially too much estrogen
with not enough progesterone,can have serious consequences.
(29:07):
So we don't, you know, we don'twant to put you at higher risk
if if we don't need to.
Leigh Klekar (29:14):
Right.
Thank you.
And then finally, how canpatients schedule an appointment
with you?
Dr. Rachel Novik (29:21):
Yeah, so I think there's a handful of ways
to schedule with our department.
You can call the Center forSpecialized Women's Health,
which is 216-444-6601.
You can call the ClevelandClinic for Her Women's Health
line, which is 216-4444 for her.
(29:43):
And then there's also theCleveland Clinic Comprehensive
Women Women's Health.
What is it?
Cleveland Clinic Women'sComprehensive Health and
Research Center, which is 4448686.
Leigh Klekar (29:59):
Great.
You and we'll put that in theshow notes too for our
listeners.
And you can actually find a lotof those phone numbers on
speakingofwomen's health.com.
Well, thank you, Dr.
Novik.
This has been great.
I appreciate you joining us onthe Speaking of Women's Health
podcast.
And thank you to our listenersfor tuning in to another episode
of the podcast.
(30:19):
We're very grateful for yoursupport and hope you will
consider supporting the podcastby sharing it with your friends
and family.
So thank you again forlistening, and we will see you
next time in the SunflowerHouse.
Be strong, be healthy, and bein charge.
Popular Podcasts
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
The Brothers Ortiz
The Brothers Ortiz is the story of two brothers–both successful, but in very different ways. Gabe Ortiz becomes a third-highest ranking officer in all of Texas while his younger brother Larry climbs the ranks in Puro Tango Blast, a notorious Texas Prison gang. Gabe doesn’t know all the details of his brother’s nefarious dealings, and he’s made a point not to ask, to protect their relationship. But when Larry is murdered during a home invasion in a rented beach house, Gabe has no choice but to look into what happened that night. To solve Larry’s murder, Gabe, and the whole Ortiz family, must ask each other tough questions.