October 9, 2025 • 46 mins
Menopause isn’t experienced equally—and the differences are too big to ignore. We sit down with Dr. Kudzai Dombo, OB-GYN and Director of Advocacy and Outreach at Alloy Health, to explore why Black women often face earlier menopause, longer and more severe symptoms, and far less access to effective treatment. Drawing on the SWAN study’s decades of data, we connect dots between evidence, everyday experiences, and the systems that shape both.
Dr. Dombo shares her own perimenopause story—misdiagnosis, expense, and relief once hormones were recognized as the driver—and uses it to illuminate the barriers many women meet: clinician bias, gaps in menopause training, insurance hurdles, and historic medical mistrust. We talk through the shocking 0.5% hormone therapy usage among Black women, why that number reflects more than preference, and how to navigate choices from bioidentical hormones to nonhormonal options. The message is clear: treatment should be personalized, iterative, and explained in simple terms that empower informed consent.
We also zoom out to where health meets work. Symptoms can derail sleep, focus, memory, and confidence—undercutting performance, promotions, and pay. We outline practical steps employers can take now: flexible scheduling for sleep disruption, breathable uniforms, localized temperature control, paid time for medical care, and benefits that cover evidence-based menopause treatment with follow-up. Finally, we highlight the power of community support groups that replace isolation with knowledge, self-advocacy, and a sense of “not just me.”
Don’t normalize suffering. If your care stalls, bring the latest guidelines, ask for options, or change providers. If this conversation resonated, subscribe, share it with a friend who needs it, and leave a review so more listeners can find evidence-based, equitable menopause care.
Dr. Kudzai Dombo is a board-certified obstetrician-gynecologist, and currently serves as the Director of Advocacy and Outreach and Prescribing Physician at Alloy.She combines deep clinical experience with a commitment to health equity, focusing especially on the midlife health of Black women.
Website: www.myalloy.com
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Email Us: info@midovia.com
MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness & supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_03 (00:00):
Welcome to the Medovia Menopause Podcast, your
trusted source for informationabout menopause and midlife.
Join us each episode as we havegreat conversations with great
people.
Tune in and enjoy the show.
Hi everyone! Did you knowMedovia has the first and only
menopause-friendly accreditationprogram in the U.S.?
(00:24):
Our program is the benchmark ofexcellence, backed by five years
of experience working withhundreds of employers around the
globe with our worldwidepartners.
You can join now with a 20%discount off your first year's
membership in honor of PeriaMenopause and World Menopause
Month.
Join before October 31st toreceive your discount by
(00:46):
visitingmenopausefriendlyus.com.
SPEAKER_02 (00:50):
Welcome to our special four-part webinar series
in recognition of MenopauseAwareness Month.
We're proud to bring thisimportant conversation to life
through a partnership betweenAlloy Health, a leader in
evidence-based menopause careand telehealth solutions, and
Medovia, the U.S.
workplace leader in menopauseand midlife health.
Throughout the series, we'llbreak down the myth, share the
(01:12):
latest science, and highlightthe real experiences of women
navigating menopause, menopause,perimenopause, and beyond.
Our goal is simple (01:20):
to replace silence with knowledge, empower
women to advocate forthemselves, and give
organizations the tools theyneed to build supportive
cultures.
Together, Alloy Health andMedovia are working to change
the way menopause and franklythis stage of life is understood
in healthcare, in the workplace,and in society.
(01:40):
So thank you for joining us aswe open the door to honest,
informed, and hopefulconversations.
Today, we are addressing Blackwomen and menopause, and Medovia
is joined by Dr.
Kudzai Dombo.
Dr.
Dombo is a board-certifiedobstetrician gynecologist and
currently serves as the Directorof Advocacy and Outreach and
(02:02):
prescribing physician at Alloy.
She combines deep clinicalexpertise and experience with a
commitment to health equity,focusing especially on the
midlife health of Black women.
Welcome to the show, Dr.
SPEAKER_00 (02:15):
Dombo.
Thank you so much, Kim.
It's such a pleasure to be heretoday.
SPEAKER_02 (02:19):
Yeah, we're happy to have you.
What drew you into this work?
We talked a little bit about itbefore we started pushing
record, but why are equity andrepresentation in women's
health, especially in midlife,important to you?
SPEAKER_00 (02:32):
Kim, that's a really great question.
And I think it started by my ownPerimenopause journey that
started about two and a halfyears ago.
And as I navigated through someof the symptoms, which weren't
typical but debilitating, Irealized that I not only number
one, wasn't aware of what wasgoing on in my body, but then
(02:53):
number two, when I encounteredthe health system, you know, I
ended up in the emergency roomfor an episode of severe dry
eye, um, where my vision wascompromised, it was just
painful, gritty, I was not ableto work.
So I had to take a week out ofwork.
I couldn't type, I could like,like I couldn't do anything.
(03:13):
And I was diagnosed as having acondition called phytokeratosis,
like in an emergency room, whichwas Welder's disease, is what he
said.
And, you know, of course, thatleaves me in a panic of what
does this mean for my career?
End up seeing a femaleophthalmologist who was in
midlife herself.
She was in her 50s, and she wasable to say, Tell me, this is an
(03:35):
actual severe form of dry eye.
And this can occur, you know,with contract chronic contact
lens use, but specifically likein midlife, when you're you
start to have hormonal changes,you know, that are consistent
with, you know, menopause orperimenopause, these are some of
the precipitating factors.
And so it was such a relief tobe able to hear that, number
one, but also to be correctlydiagnosed, and then also to have
(04:00):
to navigate, okay, what is nextfor me?
And I think the journey wasfraught with you know, pre-ops,
medications costing$700 a month.
Like it was, and I thought tomyself, if I'm having such
trouble navigating this, yeah,what is the and I'm in the
health system, I'm in the healthsystem.
(04:20):
What is the standard woman whois, you know, not within the
system, who has access to beingable to meet with a doctor
within a couple of days of anincident like this happening?
What are what is theirexperience, number one?
And then number two, as Icontinue to take care of women
who were perimenopausal andmenopausal, and I noticed that,
(04:43):
okay, the tides are changing andhow we are, you know, the
ability to really advocate forthem, like I started to see less
and less black women in theconversation in at the at
different uh in the differentrooms where we were talking
about this and having theseconversations.
And I would start to wonder,okay, if I'm one of the two, you
(05:04):
know, in a room of a hundred,where are the other women, you
know, and not only that, but isthis information getting to
them?
Because as I did more research,I understood that black women
are impacted differently, youknow, during this time.
And I felt so, you know, and Idon't know if the word is
(05:29):
inflamed, but you know,impassioned to be able to bring
the conversation to women who indifferent ways, right?
To see how we can engage them inthe conversation and help them
look at their options, not justfor symptoms, but for their
long-term, right?
(05:50):
Their long-term health care.
Because as we'll go into, youknow, black women were, you
know, higher risk forcardiovascular disease, higher
risk for hypertension, diabetes,some of the more chronic
diseases.
And this information may not beknown.
And the way to a road toprevention is really treatment
(06:15):
during before, but also duringthat menopausal transition to
reduce the risk.
SPEAKER_03 (06:20):
Yeah.
I'm so glad that you have thefire in your belly and you're
doing something to change, tochange the narrative, and
actually not change thenarrative, but bring it
forefront, right?
Because it's a really importantconversation.
Um, you mentioned that themenopause journey is different
for Black women.
And I'm wondering if you canthat a little bit for us and
(06:44):
talk us through those uniquehealth disparities that you see
in your work.
SPEAKER_00 (06:49):
Yeah, absolutely.
And I'm gonna go um and reallydiscuss the research, the data,
you know, because I think it'simportant for me to be able to
speak from information that hascome from studies.
So the Swan study, which wasstarted in the 19 like 1996, and
it spanned about two and a halfdecades.
(07:11):
And what they did was theylooked at women across the
nation.
So it stood for the study ofwomen across the nation, and
this was in all cities acrossthe United States.
Um, and what they did was theyenrolled 3,302 women, and what
they wanted to make sure of isthat they had a cohort of
(07:32):
Caucasian women, black women,Hispanic women, Japanese and
Chinese women, okay, so thatthey can kind of look at
throughout the midlifetransition, and these women were
aged between 42 and 52.
Throughout that midlifetransition, what do they find
when it comes to their menstrualperiods, to their symptoms, to
(07:52):
you know, some of the conditionsthat they experience when it
comes to, you know, uhdiscrimination.
They wanted to look at how theirbodies, what kind of exercise,
what all these different aspectsof during this midlife
transition, you know, whathappens.
And what they found specificallyfor Black women is that black
women enter menopause earlier,so approximately 1.2 years
(08:16):
earlier than Caucasian women.
And they also found that Blackwomen experienced their symptoms
longer, um, and specifically theViva motor symptoms, and they
also found that their symptomswere more frequent and they
tended to be more severe.
So these are statistically, youknow, documented um data points.
(08:39):
And I think it's also importantto know that there was a
breakdown that looked at hormonereplacement therapy or menopause
hormone therapy, as we call itnowadays, and the just
prescribing fact, you know, theprescript the prescribing
practices of physicians in 1999before the women's health
imperative, it was about 27% ofwomen were on you know hormone
(09:00):
therapy.
2020, it was about 4%.
And out of those, that 4%, whenit came to black women, it was
0.5%.
SPEAKER_03 (09:09):
0.5.
Wow.
Wow, wow.
I have never heard thatstatistically.
Oh, so that's shocking.
Stunning.
SPEAKER_00 (09:17):
Yeah.
Yeah.
So I think these are some veryreal, this is some very real
data.
Um, and it's not justobservational, it's really based
on longitudinal, you know,studies where they followed
women over time.
So they do experience a verydifferent, you know, experience.
I mean, I could go into moredetail where, you know, when
(09:38):
they looked at sleep, right?
I think it was Caucasian womentended to complain the most
about sleep symptoms, but whenthey actually did the activity,
and the activography is thetest, you know, you know, when
you have a sleep study, theyreally examine the length of
sleep they found that for blackwomen, even though they didn't
complain about it, their sleepwas on average less, you know,
(10:00):
that like in terms of the timethan it was.
They got less hours of therestful sleep than you know,
other women.
And so it's it's just importantto notice that there are very
specific changes.
I could go into even, you know,when it came to comes to
depression, you know, therethere were very specific
statistic and that statisticalanalyses that were done on a
(10:24):
large scale to assess thesedifferences.
SPEAKER_03 (10:27):
I find it interesting.
Um, so so black womenexperienced uh menopause
earlier, uh, longer and moresevere, right?
It's what you've said in anutshell.
And you're and you noted theswan study, and we're familiar
with the swan study, but youknow, we even in the menopause
(10:48):
space, we don't really hear theswan study referenced that
often.
And I find that interesting.
I'm wondering if you can canspeak to that a little bit and
also talk about some of theother root causes that might be
driving inequities, um, whetherit's in research, whether it's
in those systemic barriers inhealthcare, um wider bias.
(11:11):
I mean, we could probably have awhole podcast just on that uh
topic alone.
But can we can we move into thatconversation a little bit and
unpack that?
SPEAKER_00 (11:22):
Yes.
So when it comes to the Swanstudy and why it hasn't been
discussed, um, I, you know, I Ithink what I've seen is having
this conversation entermainstream has been the focus,
right?
Because if we're going fromshame to like a 2023 article in
(11:46):
the New York Times to like it'sjust been a building up of
really getting the conversationinto mainstream so that people
are talking about it.
Um, and I my desire is that withtime, you know, these statistics
from the Swan study will becomemore a focus.
(12:07):
Because I think right now we'refocused on like, okay, how do we
bring this about, no matter whoit is, whether it's a celebrity
that brings it out, who canbring this conversation so that
it can be taken seriously.
And so that clinicians ingeneral can realize that, you
know what, women are actuallyself-advocating for themselves
based on this information.
(12:28):
So I feel like we've reached amajor milestone.
I mean, the next milestone isthe FDA and this black box
warning, right?
So we are reaching greatmilestones.
Unfortunately, when it comes tothe Swan study, being able to
have enough voices that bring itup and talk about it, I think is
one thing that my desire is forfor, you know, as we move
(12:51):
forward.
Um, I know that, you know, thefindings around Japanese women
and Chinese women, they tendedto have less severe, you know,
symptoms compared to Caucasian,you know, and for Hispanic
women, I think what one of thethings that they noticed is that
the vaginal symptoms are whatthey complain about, even though
they have really bothersome, youknow, vasomotor symptoms.
But it was more the vaginalsymptoms that they complained
(13:13):
about.
So these are all nuances that Ithink it's important when it
comes to clinician education,right?
That this is going to beimportant when it comes to
making sure that we're lookingat equity.
Because, you know, if we're notlooking at these inequities, you
know, like what are we truly,you know, how are we truly
(13:35):
making the space equitable forwomen to see themselves
representing, representing?
And then the second question youasked was root causes, you know,
driving these inequities.
I think, again, there'sclinician bias.
I know, I think one of thethings that I know, especially
when I was still, you know,delivering babies and in the
hospital, is that, you know, weknow the maternal mortality rate
(13:58):
is three times higher for blackwomen than it is for, you know,
other women.
And so knowing that a lot of,you know, the underbelly of that
has been, you know, part of ithas been clinician bias, right?
And systemic barriers.
But I think we have to addressthat clinician bi clinician bias
because I think sometimessymptoms can be minimized and
(14:20):
reframed as stress.
And so it's really importantthat there is not just, oh, you
have to complete your um, youknow, bias training once every
two years.
SPEAKER_01 (14:34):
Right.
SPEAKER_00 (14:34):
But I think as we as we um bring about change in you
know, education for clinicians,that that bias is also something
that is consistently brought tofront.
So that as clinicians, we areaware of what our biases are,
and that that women's symptomswill not be memized or reframed
(14:57):
as stress, especially if you'rea black woman and that you can
just handle it.
So that's one.
And then I think, you know,systemic, you know, barriers
like insurance inequities, youknow, occur.
And then access, you know, tomenopause specialists, people
who are trained, you know, inbeing able to.
So what I hear a lot, especiallyin our support groups, is that,
(15:17):
you know, I have patients, blackwomen, who go out, ask their
doctors, their doctors send insynthetic hormones, and then
because they've done theirresearch, hey, I don't want
synthetic hormones, I wantbioidentical hormones.
And then it's like, okay, hereyou go.
And then the next thing they'relike, I'm bleeding.
What do I do?
(15:37):
We don't know.
So being able to have access tospecialists, you know, women who
or doctors who or clinicians whocan actually help women, you
know, is very, very important.
And that is another systemicbarrier that I have noticed.
And then I think research,right?
(15:58):
It hasn't evolved, it hasn'tinvolved a lot of black women to
date.
So even with the swan study, forevery single location, right,
they had a white cohort and thenthey had either, again, the
Hispanic, the um Chinese, theJapanese.
So every, every every locationthey have had a white court, but
they had to have, you know, acohort that represented a
(16:20):
different ethnicity.
So I think I mean, and I'm justgrateful for what this Swan
study has showed us and theinformation.
But I also think that we need todo better when it comes to you
know research in general,because even in the WHI, the
number of women, even though itwas a large study, did not have
a significant portion of blackwomen involved in that.
(16:42):
So I think that there's no datareflecting black women's
experience.
Yeah.
Besides one.
SPEAKER_03 (16:49):
That's interesting to me.
Um, there's layers, right?
There's not enough um researchfor women in general, period.
Um, let's note that.
And then you add that additionallayer on top of, right?
So now we don't have um, youknow, we don't have
representation for Black womenwith the little research that we
have for women in general.
(17:11):
So it's it is an obstacle.
And I, you know, I think oftenabout um the insurance, um, the
way that our health care isstructured today and the
inequities that we are, it seemslike we are uh we're not doing
better.
We're doing, we're going theother direction right now.
Um and I can see where thatwould be extremely challenging.
(17:32):
Hopefully that is changing.
Um that there are, you know,alloy does a fantastic job in
caring for women in menopause,but certainly not having access
to certified menopausespecialists, um, you know, is
another barrier.
Um you're being dismissed byyour um GP or you know, fill in
(17:56):
the blank, whoever it is thatyou're seeing um that they're
they're not, they don't know.
Um I'll give them that maybe,right?
We don't know because we we knowthat they're not um not, we have
a very limited number ofphysicians that are trained in
menopause adequately.
So another layer, right?
Yeah.
Right.
It's complicated.
SPEAKER_00 (18:16):
Yeah.
And I think there's one lastthing, April, the mistrust in
the medical system that I seewithin, you know, you know, in
general, like black women, notall black women, but I think
there is this underlyingfundamental like, you know,
mistrust.
And it's rooted in historical,you know, you know, things that
have happened, historical harm.
(18:38):
So overcoming that as well is ahuge um part of, you know, what
what what is contributing tothese inequities is is really
this mistrust.
And how do we, you know, outsideof a community, how do we really
address this so that women canunderstand that, you know, okay,
(19:01):
we'll walk you through yourprocess, you know, to getting
what you are comfortable withat, you know, at as you go along
with it.
Because I really do believe, youknow, in hormone therapy for
those who are candidates interms of reducing the risk for
chronic disease and even when wetalk about longevity, you know,
(19:23):
estrogen is a very in general,you know, more harmless than it
is harmful.
And it obviously involves a verypersonalized approach so that
patients can understand, youknow, okay, let's address that
there is a little bit ofmistrust, but let's educate you
(19:44):
as well, you know, as what thepros and cons of all the options
are.
SPEAKER_03 (19:50):
Do you think black women are suffering more?
Um because of that, you know,I'm I'm it it really I have to
ask that question because umbecause I'm truly curious.
I I don't know woman.
Um, do you think that becausethere is that mistrust uh with
the healthcare system that blackwomen are suffering uh more?
SPEAKER_00 (20:11):
I I do, I do, and or they're willing.
I shouldn't say that, butthere's a level of, okay, I'm
I'd rather just go this routeversus this, you know, I can
navigate, you know, sufferingthrough.
Um because there is that levelof, uh, I'm not sure.
(20:33):
I don't want to add anythinginto my body.
And when you break it down forthem and share with them that,
especially with bioidenticalhormone therapy, all I'm doing
is replacing a little bit ofwhat your ovaries aren't
naturally producing anymore.
That's all it is.
And it's almost like, you know,like it's like a wow, I've never
heard of it like that.
(20:54):
If that's all it is, you know,because explaining to them that
this is bioidentical, this issimilar in structure to what
your ovary naturally produces,it really makes a difference for
them be, you know, to be willingeven to take take the first
step, you know, versus it havingthis connotation that, oh,
(21:14):
they're treating me withhormones and their side effects
and all these different thingsthat could happen to me.
I feel like it really requiresjust breaking it down simply.
SPEAKER_02 (21:24):
And I can also imagine that if you know you're
hanging around with your groupof friends and nobody's doing
anything about this and is notinformed, then why would you go
out on a limb to, you know, dosomething that somebody that you
don't even know or looks likeyou is doing and you know, we
don't talk about it and it'sfine, and I'll get through it.
Because when I look around atyou know, my peer group, we're
(21:48):
all in, we're all like talkingabout that.
This is an important thing,probably because this is what I
do all day long.
This is what we do, right?
That's what I do all day long.
But I I know that if I didn'tsee people like me who or no one
was talking about it andeveryone was just suffering to
get through it, because thatwe've done that so many times
with so many other things thatit would be a hard sort of mind
(22:10):
to change.
SPEAKER_00 (22:12):
100%.
And I have a story for youbecause I had a very specific
patient who found me onInstagram.
I brought her into Alloy becauseI was like, look, we can't
communicate on Instagram abouthealth issues.
And so she came into you know,alloy, and we went through
absolutely everything.
She had a group of friends andthey were Buddhist, you know,
(22:34):
and she was black, but she hadher Buddhist group of friends,
and they all had told herhormone, she had prescribed to
what they prescribed through,and they had basically were like
anti-hormones.
And so it wasn't until shestarted to be like, okay, I'm
starting to feel miserable, andI'm starting to see Oprah's
talking about it.
All these different people aretalking about it.
And so now I'm gonna do myresearch.
(22:55):
So she took time to do herresearch while she was doing her
research.
She had her doctor start her onVIOSA, which is in non-hormonal
therapy.
But then by the time she came tome, she DM'd me, brought her
into Alloy.
We did a full consult where wewent through all her options,
you know, and she was ready.
She was ready and she said, I'mactually going to choose this
(23:15):
for me, because even though myfriend group isn't there, I want
to be able to plan for not onlywhat I'm dealing with now, but
also for my long-term health.
And she probably and it was avictory, yeah, for her.
SPEAKER_02 (23:29):
And she probably told her friends.
Yeah, there's a ripple effect onthe other side.
Yeah.
Yeah.
Yeah.
Um, okay, switching gears alittle bit.
Um, I read a New York Timesarticle recently that um black
women have been experiencingmore unemployment in the past
two years, that the workforcehit black women particularly
(23:52):
hard.
SPEAKER_01 (23:52):
Yeah.
SPEAKER_02 (23:53):
How does menopause intersect with race and
workplace inequities as it comesto menopause?
Because I was surprised by that.
And I know that you know, thewomen that are probably being
laid laid off in the federalworkforce have worked there
forever and are probably ofmenopause age.
And so it again, the workplaceis being, you know, in uh
(24:18):
discrimination, you know, inintentionally discriminating
with women in the workplace.
But can you talk about the sortof race and workplace inequities
as it's related to menopause forblack women?
SPEAKER_00 (24:30):
Yeah.
And so I think just as you said,I think in general, black women
are already navigating these,either whether it's pay gaps,
racial bias, they face an extraburden when it just comes to the
workforce in general.
But when you think about goingthrough menopause, and I've seen
this with my patients, you know,their symptoms, they affect
(24:51):
their concentration, theirenergy, their confidence.
And when that starts to happen,you really need a level of
workplace support, right?
In whatever way that looks like.
So I have patients who have toldme that they either are business
owners, they can't get off thecouch because of these symptoms.
They're just energy is depleted.
(25:13):
You know, they're running theirown businesses and it's just
like, I just don't have theenergy to do it.
I have other patients who, youknow, are responsible for
billion-dollar contracts, right?
And they are unable to, likethey're in meetings and their
confidence is affected becausetheir memory is, you know, they
have issues with their memory,concentration, and they are
(25:35):
really lacking confidence whenit comes to, oh my gosh, what is
it that I, you know, need to donow?
Because I really think that myboss is not going to fire me,
but they're just thinking mywork performance is poor and I'm
going to be in trouble with, youknow, at my work evaluation.
So I think when it comes toblack women in general and what
(25:58):
we're seeing with these federallayoffs, so I can't control
what's happening with thefederal government because
they're choosing to do like, orwe can't control what's
happening right now.
But I do think that when youlook at the workspace for black
women, they're even going to bemore impacted because you know,
(26:19):
if they're not getting the curefor some of the symptoms that
they're experiencing that areaffecting their performance,
right?
You know, without that workplacesupport, you're gonna have mixed
missed promotions, you know,when it comes time for promoting
somebody, if they're havingissues with concentration,
they're not gonna really be onthe top, you know, tier for a
(26:41):
promotion, reduced pay, youknow, and some of them cut back
from their careers, right?
You know, and that's the sadpart because, you know, I one of
my greatest joys is being ableto see some of these women, you
know, go from where they were,start hormones, and then they're
just like, oh my gosh, you know,I'm actually participating in
(27:02):
meetings, and I feel yeah, and Ifeel like I feel better.
And you know, all that lack ofconfidence that comes with you
know your symptoms, it goesaway.
And you know, I see patients andI'm like, you're a different
person.
So, so, so, so I think lookingat you know, black women, again,
(27:27):
0.5% on hormone therapy, youknow, to be able to like have
like you know, and a lot ofblack women have more physically
demanding, you know, jobpositions.
So this already sets them backto some degree, you know,
because 0.5% is a very low dose,low low percentage of black
(27:54):
women who are on hormonetherapy.
And as we know, this can besomething that's really helpful
in just restoring the estradiollevels and getting you back to
um a better performance, whetherit's mental clarity, you know,
and all the different thingsthat can contribute to, you
know, reduced performance.
SPEAKER_03 (28:14):
So the um access to healthcare uh is important, you
know, I'm hearing that over andover and over again here uh in
this conversation, so that theycan get the support that they
need.
I'm wondering as we think aboutemployers and the workplace,
because that's the space that wesit, right?
Um I'm wondering what roleemployers can play in reducing
(28:39):
those healthcare disparities.
So, you know, moving beyond, um,I don't want to say just um
healthcare benefits, becauseit's extremely important to have
those benefits to get the helpthat they need so that they can
get back to the workforce andperform at that at that peak,
right?
With the confidence, yeah,feeling better.
It's really important.
But what else can employers doum to play a role there in re in
(29:04):
in reducing those healthcaredisparities?
SPEAKER_00 (29:07):
Yeah.
And that is such a greatquestion because I think, yeah,
okay, awareness is one thing,but I think changing policies is
really where, you know, the thethe the you know, that speaks
volumes.
Okay.
And so when I think about um,you know, flexible scheduling,
you know, there may be women whohave really debilitating
(29:27):
problems with their sleep andmaybe just starting a little
later, you know, and and endinga little like having that
flexibility for scheduling, Ithink is is is one core aspect.
Um, if you have to wear auniform at work, having
breathable, you know, materialso that it's not something
that's gonna, you know, be worseoff for you if you are having
(29:53):
and experiencing the hot blushesum and uh you know, sweats,
having having material that'sbreathable that's that's one way
to look at it I think you know Ilook at temperature controls
like do patients have like do doum employees have the ability to
you know regulate temperaturewithin their spaces um and then
(30:14):
I think you know even looking atpaid time off for doctor visits
you know does that employeroffer time for patients to
actually you know get the carethat they need because I think
sometimes you're looking at oh Idon't want to take the time off
because I won't get paid for itbut then is there that time paid
off available um and then Ithink you know insurance
(30:37):
covering you know menopause careso that women can go over all
their options and know whattheir options are and then I
think it's important to knowthat okay if one course of
treatment isn't working let'smove on to another so that you
know women don't feel likethey're stuck in a okay I used
my one benefit or one whateverthat I get like but that is
(30:58):
something that's available youknow consistently so that you
know I think what I found isthat validation and options are
something that women like evenjust getting that it's like a
huge weight off their shouldersand they feel like more
empowered in this journey.
(31:19):
So it's not just okay you hadyour appointment here's your
treatment goodbye.
Right they need that um and thentraining managers because I
think sometimes managers okayyou can but what what are you
training them to be looking foryou know in some of the the the
women because I think what tendsto happen is if a manager isn't
(31:42):
isn't aware of what maybe whatsome of the what the lived
experience is of you know theirthe employees it's really hard
for the manager to be able toidentify and ask more questions.
SPEAKER_02 (31:57):
Yeah you know when they see something you know
within a patient likeconcentration they're not like
the assumption can always be ohyou know not working hard enough
not you know and so I think itwould be nice to be able to
train or efficient like it wouldbe imperative I shouldn't say
nice imperative you know formanagers to be trained to be
(32:18):
able to identify those are thoseare great those are all the
answers that we usually talkabout on why supporting women in
the in the menopause space isimportant.
I want to go back to somethingyou just said a few minutes ago
about you know start tryingsomething and then you got to
keep sometimes you got to tweakit.
You got to be experiment and yougot to get curious about what's
(32:41):
working for you.
And I don't know if I mean myexperience is that women are not
good at that I take theprescription and I just deal and
I would imagine that youprobably have to talk to your
patients and I don't know ifthis is a a black woman issue or
not but really figuring out whatworks for you might take a
minute.
(33:02):
And and and it takes some timeto figure it out and you might
have to experiment a little bitto feel really good.
But feeling good is just soimportant especially at the
stage of life where we'resandwiched between you know
taking care of our children andour parents and you know our
careers and all those kinds ofthings to feel crappy in the
(33:22):
middle of that is not helpful atall.
Can you speak to that a littlebit?
SPEAKER_00 (33:27):
Yeah no I I completely like understand what
you're saying about feeling goodand what I find with patients is
um it's so interesting becausethis is what I have to tell
them.
They come and they're like soconfused about okay do I do this
but then if I lock myself intothis then you know or should I
(33:49):
choose this and you know andthen if I lock myself into this
like they see it as a fixed onefixed solution.
Meanwhile this is like trial anderror and I tell patients this
all the time your body and yourgirlfriend's body are completely
different bodies okay so yourgenetics your body chemistry is
going to be different.
(34:10):
So what worked for her may notwork for you.
And I think changing the mindsetthat it may take a little bit to
get you to the sweet spot.
So we may start you withprogesterone only if you're an
early perimenopause after threemonths because that's usually
how long it takes to adjust toany form of like you know a new
(34:31):
hormone within your system rightwe all have estrogen receptors
in different parts and how thoseestrogen receptors respond, it
can take a minute you knowbecause it's again we have them
all over our bodies we maynotice some side effects we may
and again it takes your bodywhat a good few weeks if you
have side effects for them to goaway.
(34:53):
And so I think it's reallyimportant to understand that,
you know, okay we start withinthree months we're looking at
making tweaks if necessary andthen boom we go another three to
six months we need to maketweaks we do that if necessary.
So it's not a one size fits allit's very personalized.
And your symptoms the ones thatare the most burdensome are
(35:17):
different from somebody else'sso we will only know what works
for your body based on what youtell us and we try to tailor it
to again not only your symptomsbut your age your family history
your medical history right andyour allergies so there are a
lot of factors that come intoplay in determining where we
(35:39):
start and then also how we makeadjustments after three months.
I've had women who it takes ayear for them to get to a point
where you know they know thatthings work.
So that's where I always tellpatients that it's important to
be patient with your body andthat this is a journey.
You know we're we're it's not aone and done it's it's it's it's
(36:01):
a journey where we you knowrequire frequent check-ins to
see what modifications need tobe done.
SPEAKER_02 (36:07):
I think that's huge for all women to understand
we're all different.
SPEAKER_03 (36:11):
Yeah yeah my symptoms are different than
Kim's and yours and right um andwe all have comfort levels and
how we want to manage thosesymptoms and to your point our
backgrounds and our genetics andit's all different.
So I I love that you bring thatup because we sing that song
every time we gather with agroup of women we were just
(36:31):
saying that last night in thefireside chat and we were also
it's interesting you saidsomething earlier too that I
want to come back to um it'sit's interesting that you
mentioned community groups umbecause at the end of the
fireside chat last night umreally the conversation turned
to isn't this great that we haveeach other that we can we can
(36:53):
share ideas we can share what'sworking for one maybe have you
tried this and I think that'simportant because you don't know
what you don't know right oh Ididn't realize that that was
available so I'll I'll ask myhealthcare provider about that.
The the community groups and umsupport building that tribe is
really important.
And I know that there's researchthat shows that it will actually
(37:15):
lessen our symptoms just bythinking about it and being
there's you co-lead uh supportgroups, right?
Wellness support group.
And I'm wondering what you'rehearing directly from the women
in your support groups and I'malso wondering how that can help
fill gaps with the traditionalhealthcare systems.
SPEAKER_00 (37:36):
Yeah it's it's I mean they're powerful they're so
powerful uh we get you knowblack women from you know
different parts of the countryand um the one thing that I know
is that I hear women share aboutI thought it was just me.
Right always you know I thoughtit was just me.
(37:56):
And then I also see you know howto learn self-advocacy right so
one woman who maybe furtheralong in her journey and then
somebody else who's juststarting her journey they are
actually like wow you know Inever thought to ask my doctor
that and so you know we havewomen come back just as I shared
(38:17):
earlier wow next time you I comeback you're gonna hear that I'm
on hormones you know forsomebody who was not a believer
in them.
You know I had another patientwho was on hormone therapy and
she had a history of fibroidshad started some irregular
bleeding and they couldn't getit under control.
So they told her okay let's do ahysterectomy because she was 55.
And you know what she did?
She said you know what I want toknow what my other options are
(38:40):
you know and she came to thegroup and she asked hey I was
looking them up and a uterineartery embolization I looked at
and I thought about that.
Lo and behold there was somebodyelse who had a uterine artery
embolization in the group shecould share her experience and
just things to consider.
And it was such a moment of umuh like integrative support and
(39:04):
her feeling good about beingable to go back to her doctor
and share why she wanted thisyou know more empowered and so I
think you know learning thatself-advocacy is something that
I see in the groups and then Ithink it's like you know just of
course group validation you knowshared solutions you know women
(39:27):
come back and say okay well thisworked for me or I tried this
you know sugar that'snon-glycemic or you know it's
more expensive but this is whatreally helped me get you know my
um blood sugar control improvedwhen I chose to adjust my
nutrition you know and sothere's this sense of
(39:48):
sisterhood.
It's like I'm looking out foryou you're looking out for me I
want to help you understand whatworked for me with my skin
symptoms like I use this brand Iuse that brand and it helped me
again I'm just sharing knowledgethat I've gained and I think
that you know really fills thegaps that the traditional
healthcare system leaves open.
(40:10):
And they feel like okay yes Imay not have had a long
conversation with my clinicianbut I came to this hour support
group and I felt like wow thisanswered my question because I
could tell her what a uterineexactly was right explain it,
how it's done, what some of theside effects may be, you know,
and I'm not sharing this withthem as their doctor but just as
(40:33):
a source you know of you knowmedical information that they
may not necessarily get withinthat short visit with their
doctors.
And then they have thatinformation and they can then
take that to their healthprovider right yeah yeah so yeah
works both based I love thatbefore we move on I want to um
just can you please tell us howum our listeners can be a part
(40:57):
of those community groups yeahum so alloy at www.alloy.com we
actually have a um I'm gonnasend this to you we have um
event rights and we actuallysend them out um every for you
know and as long as you're onthe email list we can actually
send you one you can registerand then as long as you're on
(41:19):
the email list you'll you'll getthem you know every time they go
out and that way you'll knowwhen they are at least a week
before and we do them twice amonth.
So that allows women who aren'table to attend every month but
we have women who come everysingle time we have like a crew
of women who are you know whoare like these are my people now
(41:42):
and yep yeah yeah it feels goodto be a part of a community that
you're familiar with we all wantit we all want that right yeah I
want to feel connected and Ialso have younger perimenopausal
women like in their early 40swho actually come and they say I
am so glad I am getting to hearthis see this learn this so that
(42:05):
when my symptoms get worse rightit's just good to see women who
look like me who I can actuallybe like wow yeah I know what to
expect.
SPEAKER_02 (42:18):
That's fantastic.
Dr.
Dumbo we could talk for anothercouple hours um really
appreciate your um knowledgeexperience your um what did you
call it fire in your belly firein your belly yeah I love I just
I just love that but if youcould leave our listeners with
one key takeaway um what wouldwhat would you want to leave
(42:39):
them with?
SPEAKER_00 (42:41):
I would say don't normalize suffering I did that
you know and I ended up withdebilitating symptoms where I
actually started to cut down onmy shifts at work because I was
doing 24 hour shifts but don'tnormalize suffering you know
because I think you can it'svery easy to say oh my gosh I'm
getting older because I'm 50turning 52 and I was like okay
(43:04):
this is maybe just what happensas I get older you know and and
I normalized it to the pointwhere I you know I was you know
in emergency room but I justdidn't know what was going on.
So that is one thing that Iwould say do not normalize
suffering.
And then I I would also say youknow um you know if your
(43:26):
clinician is not being proactiveyou know in addressing your
symptoms and discussing all ofyour options because I think
it's really important for thereto be agency you know you you
have you you leave feeling witha sense of agency.
There are always other optionsand you can always give your
(43:48):
clinician you know umopportunity by maybe taking an
article with the 2022guidelines, you know, for
menopause, you know, hormonetherapy if you really are
considering hormones.
But I also say that if you'rereaching a wall, you know your
your story is not over likethere's always somebody else or
there is somebody else who wouldbe able to help you.
SPEAKER_03 (44:10):
That's great.
We always say you can divorceyour you can divorce your
divorce your done if you if youneed to yes and go find it's
okay.
SPEAKER_00 (44:18):
Yeah absolutely yeah absolutely so where can people
find you um I am at alloywomen's health or x it's
www.alloy.com excuse me my alloydot com so they can find me at
alloy and that's where I spendmajority of my time excellent
and you're on Instagram you knowyes I'm on oh that's right and
(44:41):
on Instagram at dr dot couldseyefantastic where I try to share
pearls show notes okay yeah I'mgonna go follow you as well yeah
okay wonderful before before wesign off we ask everyone what
the best piece of advice you'veever received has been what
would you say to that followyour gut you know follow your
(45:04):
internal like that internalvoice about what you may
experience or feel and know thatone door that may appear to be
closed there's another door opensomewhere else so I do that for
patients for other cliniciansfor myself I think it's really
(45:26):
like we have wisdom within usand we know.
SPEAKER_03 (45:30):
We do just we do and when we go against gut
oftentimes it doesn't work out.
So we need to listen to our gut.
Yeah yeah thank you for that andthank you so much for spending
this time with us and sharingyour expertise I'm sure we'll
have you back because there wasa lot that we didn't have an
opportunity to discuss.
But until we meet again go findjoin the journey.
(45:51):
Yeah absolutely thank you somuch take good care all right
bye bye thank you for listeningto the Medovia menopause podcast
if you enjoyed today's showplease give it a thumbs up
subscribe for future episodesleave a review and share this
episode with a friend.
Medovia is out to change thenarrative learn more at
(46:13):
medovia.com that's M I D O V I Adot com
Welcome to the Medovia Menopause Podcast, your
trusted source for informationabout menopause and midlife.
Join us each episode as we havegreat conversations with great
people.
Tune in and enjoy the show.
Hi everyone! Did you knowMedovia has the first and only
menopause-friendly accreditationprogram in the U.S.?
(00:24):
Our program is the benchmark ofexcellence, backed by five years
of experience working withhundreds of employers around the
globe with our worldwidepartners.
You can join now with a 20%discount off your first year's
membership in honor of PeriaMenopause and World Menopause
Month.
Join before October 31st toreceive your discount by
(00:46):
visitingmenopausefriendlyus.com.
SPEAKER_02 (00:50):
Welcome to our special four-part webinar series
in recognition of MenopauseAwareness Month.
We're proud to bring thisimportant conversation to life
through a partnership betweenAlloy Health, a leader in
evidence-based menopause careand telehealth solutions, and
Medovia, the U.S.
workplace leader in menopauseand midlife health.
Throughout the series, we'llbreak down the myth, share the
(01:12):
latest science, and highlightthe real experiences of women
navigating menopause, menopause,perimenopause, and beyond.
Our goal is simple (01:20):
to replace silence with knowledge, empower
women to advocate forthemselves, and give
organizations the tools theyneed to build supportive
cultures.
Together, Alloy Health andMedovia are working to change
the way menopause and franklythis stage of life is understood
in healthcare, in the workplace,and in society.
(01:40):
So thank you for joining us aswe open the door to honest,
informed, and hopefulconversations.
Today, we are addressing Blackwomen and menopause, and Medovia
is joined by Dr.
Kudzai Dombo.
Dr.
Dombo is a board-certifiedobstetrician gynecologist and
currently serves as the Directorof Advocacy and Outreach and
(02:02):
prescribing physician at Alloy.
She combines deep clinicalexpertise and experience with a
commitment to health equity,focusing especially on the
midlife health of Black women.
Welcome to the show, Dr.
SPEAKER_00 (02:15):
Dombo.
Thank you so much, Kim.
It's such a pleasure to be heretoday.
SPEAKER_02 (02:19):
Yeah, we're happy to have you.
What drew you into this work?
We talked a little bit about itbefore we started pushing
record, but why are equity andrepresentation in women's
health, especially in midlife,important to you?
SPEAKER_00 (02:32):
Kim, that's a really great question.
And I think it started by my ownPerimenopause journey that
started about two and a halfyears ago.
And as I navigated through someof the symptoms, which weren't
typical but debilitating, Irealized that I not only number
one, wasn't aware of what wasgoing on in my body, but then
(02:53):
number two, when I encounteredthe health system, you know, I
ended up in the emergency roomfor an episode of severe dry
eye, um, where my vision wascompromised, it was just
painful, gritty, I was not ableto work.
So I had to take a week out ofwork.
I couldn't type, I could like,like I couldn't do anything.
(03:13):
And I was diagnosed as having acondition called phytokeratosis,
like in an emergency room, whichwas Welder's disease, is what he
said.
And, you know, of course, thatleaves me in a panic of what
does this mean for my career?
End up seeing a femaleophthalmologist who was in
midlife herself.
She was in her 50s, and she wasable to say, Tell me, this is an
(03:35):
actual severe form of dry eye.
And this can occur, you know,with contract chronic contact
lens use, but specifically likein midlife, when you're you
start to have hormonal changes,you know, that are consistent
with, you know, menopause orperimenopause, these are some of
the precipitating factors.
And so it was such a relief tobe able to hear that, number
one, but also to be correctlydiagnosed, and then also to have
(04:00):
to navigate, okay, what is nextfor me?
And I think the journey wasfraught with you know, pre-ops,
medications costing$700 a month.
Like it was, and I thought tomyself, if I'm having such
trouble navigating this, yeah,what is the and I'm in the
health system, I'm in the healthsystem.
(04:20):
What is the standard woman whois, you know, not within the
system, who has access to beingable to meet with a doctor
within a couple of days of anincident like this happening?
What are what is theirexperience, number one?
And then number two, as Icontinue to take care of women
who were perimenopausal andmenopausal, and I noticed that,
(04:43):
okay, the tides are changing andhow we are, you know, the
ability to really advocate forthem, like I started to see less
and less black women in theconversation in at the at
different uh in the differentrooms where we were talking
about this and having theseconversations.
And I would start to wonder,okay, if I'm one of the two, you
(05:04):
know, in a room of a hundred,where are the other women, you
know, and not only that, but isthis information getting to
them?
Because as I did more research,I understood that black women
are impacted differently, youknow, during this time.
And I felt so, you know, and Idon't know if the word is
(05:29):
inflamed, but you know,impassioned to be able to bring
the conversation to women who indifferent ways, right?
To see how we can engage them inthe conversation and help them
look at their options, not justfor symptoms, but for their
long-term, right?
(05:50):
Their long-term health care.
Because as we'll go into, youknow, black women were, you
know, higher risk forcardiovascular disease, higher
risk for hypertension, diabetes,some of the more chronic
diseases.
And this information may not beknown.
And the way to a road toprevention is really treatment
(06:15):
during before, but also duringthat menopausal transition to
reduce the risk.
SPEAKER_03 (06:20):
Yeah.
I'm so glad that you have thefire in your belly and you're
doing something to change, tochange the narrative, and
actually not change thenarrative, but bring it
forefront, right?
Because it's a really importantconversation.
Um, you mentioned that themenopause journey is different
for Black women.
And I'm wondering if you canthat a little bit for us and
(06:44):
talk us through those uniquehealth disparities that you see
in your work.
SPEAKER_00 (06:49):
Yeah, absolutely.
And I'm gonna go um and reallydiscuss the research, the data,
you know, because I think it'simportant for me to be able to
speak from information that hascome from studies.
So the Swan study, which wasstarted in the 19 like 1996, and
it spanned about two and a halfdecades.
(07:11):
And what they did was theylooked at women across the
nation.
So it stood for the study ofwomen across the nation, and
this was in all cities acrossthe United States.
Um, and what they did was theyenrolled 3,302 women, and what
they wanted to make sure of isthat they had a cohort of
(07:32):
Caucasian women, black women,Hispanic women, Japanese and
Chinese women, okay, so thatthey can kind of look at
throughout the midlifetransition, and these women were
aged between 42 and 52.
Throughout that midlifetransition, what do they find
when it comes to their menstrualperiods, to their symptoms, to
(07:52):
you know, some of the conditionsthat they experience when it
comes to, you know, uhdiscrimination.
They wanted to look at how theirbodies, what kind of exercise,
what all these different aspectsof during this midlife
transition, you know, whathappens.
And what they found specificallyfor Black women is that black
women enter menopause earlier,so approximately 1.2 years
(08:16):
earlier than Caucasian women.
And they also found that Blackwomen experienced their symptoms
longer, um, and specifically theViva motor symptoms, and they
also found that their symptomswere more frequent and they
tended to be more severe.
So these are statistically, youknow, documented um data points.
(08:39):
And I think it's also importantto know that there was a
breakdown that looked at hormonereplacement therapy or menopause
hormone therapy, as we call itnowadays, and the just
prescribing fact, you know, theprescript the prescribing
practices of physicians in 1999before the women's health
imperative, it was about 27% ofwomen were on you know hormone
(09:00):
therapy.
2020, it was about 4%.
And out of those, that 4%, whenit came to black women, it was
0.5%.
SPEAKER_03 (09:09):
0.5.
Wow.
Wow, wow.
I have never heard thatstatistically.
Oh, so that's shocking.
Stunning.
SPEAKER_00 (09:17):
Yeah.
Yeah.
So I think these are some veryreal, this is some very real
data.
Um, and it's not justobservational, it's really based
on longitudinal, you know,studies where they followed
women over time.
So they do experience a verydifferent, you know, experience.
I mean, I could go into moredetail where, you know, when
(09:38):
they looked at sleep, right?
I think it was Caucasian womentended to complain the most
about sleep symptoms, but whenthey actually did the activity,
and the activography is thetest, you know, you know, when
you have a sleep study, theyreally examine the length of
sleep they found that for blackwomen, even though they didn't
complain about it, their sleepwas on average less, you know,
(10:00):
that like in terms of the timethan it was.
They got less hours of therestful sleep than you know,
other women.
And so it's it's just importantto notice that there are very
specific changes.
I could go into even, you know,when it came to comes to
depression, you know, therethere were very specific
statistic and that statisticalanalyses that were done on a
(10:24):
large scale to assess thesedifferences.
SPEAKER_03 (10:27):
I find it interesting.
Um, so so black womenexperienced uh menopause
earlier, uh, longer and moresevere, right?
It's what you've said in anutshell.
And you're and you noted theswan study, and we're familiar
with the swan study, but youknow, we even in the menopause
(10:48):
space, we don't really hear theswan study referenced that
often.
And I find that interesting.
I'm wondering if you can canspeak to that a little bit and
also talk about some of theother root causes that might be
driving inequities, um, whetherit's in research, whether it's
in those systemic barriers inhealthcare, um wider bias.
(11:11):
I mean, we could probably have awhole podcast just on that uh
topic alone.
But can we can we move into thatconversation a little bit and
unpack that?
SPEAKER_00 (11:22):
Yes.
So when it comes to the Swanstudy and why it hasn't been
discussed, um, I, you know, I Ithink what I've seen is having
this conversation entermainstream has been the focus,
right?
Because if we're going fromshame to like a 2023 article in
(11:46):
the New York Times to like it'sjust been a building up of
really getting the conversationinto mainstream so that people
are talking about it.
Um, and I my desire is that withtime, you know, these statistics
from the Swan study will becomemore a focus.
(12:07):
Because I think right now we'refocused on like, okay, how do we
bring this about, no matter whoit is, whether it's a celebrity
that brings it out, who canbring this conversation so that
it can be taken seriously.
And so that clinicians ingeneral can realize that, you
know what, women are actuallyself-advocating for themselves
based on this information.
(12:28):
So I feel like we've reached amajor milestone.
I mean, the next milestone isthe FDA and this black box
warning, right?
So we are reaching greatmilestones.
Unfortunately, when it comes tothe Swan study, being able to
have enough voices that bring itup and talk about it, I think is
one thing that my desire is forfor, you know, as we move
(12:51):
forward.
Um, I know that, you know, thefindings around Japanese women
and Chinese women, they tendedto have less severe, you know,
symptoms compared to Caucasian,you know, and for Hispanic
women, I think what one of thethings that they noticed is that
the vaginal symptoms are whatthey complain about, even though
they have really bothersome, youknow, vasomotor symptoms.
But it was more the vaginalsymptoms that they complained
(13:13):
about.
So these are all nuances that Ithink it's important when it
comes to clinician education,right?
That this is going to beimportant when it comes to
making sure that we're lookingat equity.
Because, you know, if we're notlooking at these inequities, you
know, like what are we truly,you know, how are we truly
(13:35):
making the space equitable forwomen to see themselves
representing, representing?
And then the second question youasked was root causes, you know,
driving these inequities.
I think, again, there'sclinician bias.
I know, I think one of thethings that I know, especially
when I was still, you know,delivering babies and in the
hospital, is that, you know, weknow the maternal mortality rate
(13:58):
is three times higher for blackwomen than it is for, you know,
other women.
And so knowing that a lot of,you know, the underbelly of that
has been, you know, part of ithas been clinician bias, right?
And systemic barriers.
But I think we have to addressthat clinician bi clinician bias
because I think sometimessymptoms can be minimized and
(14:20):
reframed as stress.
And so it's really importantthat there is not just, oh, you
have to complete your um, youknow, bias training once every
two years.
SPEAKER_01 (14:34):
Right.
SPEAKER_00 (14:34):
But I think as we as we um bring about change in you
know, education for clinicians,that that bias is also something
that is consistently brought tofront.
So that as clinicians, we areaware of what our biases are,
and that that women's symptomswill not be memized or reframed
(14:57):
as stress, especially if you'rea black woman and that you can
just handle it.
So that's one.
And then I think, you know,systemic, you know, barriers
like insurance inequities, youknow, occur.
And then access, you know, tomenopause specialists, people
who are trained, you know, inbeing able to.
So what I hear a lot, especiallyin our support groups, is that,
(15:17):
you know, I have patients, blackwomen, who go out, ask their
doctors, their doctors send insynthetic hormones, and then
because they've done theirresearch, hey, I don't want
synthetic hormones, I wantbioidentical hormones.
And then it's like, okay, hereyou go.
And then the next thing they'relike, I'm bleeding.
What do I do?
(15:37):
We don't know.
So being able to have access tospecialists, you know, women who
or doctors who or clinicians whocan actually help women, you
know, is very, very important.
And that is another systemicbarrier that I have noticed.
And then I think research,right?
(15:58):
It hasn't evolved, it hasn'tinvolved a lot of black women to
date.
So even with the swan study, forevery single location, right,
they had a white cohort and thenthey had either, again, the
Hispanic, the um Chinese, theJapanese.
So every, every every locationthey have had a white court, but
they had to have, you know, acohort that represented a
(16:20):
different ethnicity.
So I think I mean, and I'm justgrateful for what this Swan
study has showed us and theinformation.
But I also think that we need todo better when it comes to you
know research in general,because even in the WHI, the
number of women, even though itwas a large study, did not have
a significant portion of blackwomen involved in that.
(16:42):
So I think that there's no datareflecting black women's
experience.
Yeah.
Besides one.
SPEAKER_03 (16:49):
That's interesting to me.
Um, there's layers, right?
There's not enough um researchfor women in general, period.
Um, let's note that.
And then you add that additionallayer on top of, right?
So now we don't have um, youknow, we don't have
representation for Black womenwith the little research that we
have for women in general.
(17:11):
So it's it is an obstacle.
And I, you know, I think oftenabout um the insurance, um, the
way that our health care isstructured today and the
inequities that we are, it seemslike we are uh we're not doing
better.
We're doing, we're going theother direction right now.
Um and I can see where thatwould be extremely challenging.
(17:32):
Hopefully that is changing.
Um that there are, you know,alloy does a fantastic job in
caring for women in menopause,but certainly not having access
to certified menopausespecialists, um, you know, is
another barrier.
Um you're being dismissed byyour um GP or you know, fill in
(17:56):
the blank, whoever it is thatyou're seeing um that they're
they're not, they don't know.
Um I'll give them that maybe,right?
We don't know because we we knowthat they're not um not, we have
a very limited number ofphysicians that are trained in
menopause adequately.
So another layer, right?
Yeah.
Right.
It's complicated.
SPEAKER_00 (18:16):
Yeah.
And I think there's one lastthing, April, the mistrust in
the medical system that I seewithin, you know, you know, in
general, like black women, notall black women, but I think
there is this underlyingfundamental like, you know,
mistrust.
And it's rooted in historical,you know, you know, things that
have happened, historical harm.
(18:38):
So overcoming that as well is ahuge um part of, you know, what
what what is contributing tothese inequities is is really
this mistrust.
And how do we, you know, outsideof a community, how do we really
address this so that women canunderstand that, you know, okay,
(19:01):
we'll walk you through yourprocess, you know, to getting
what you are comfortable withat, you know, at as you go along
with it.
Because I really do believe, youknow, in hormone therapy for
those who are candidates interms of reducing the risk for
chronic disease and even when wetalk about longevity, you know,
(19:23):
estrogen is a very in general,you know, more harmless than it
is harmful.
And it obviously involves a verypersonalized approach so that
patients can understand, youknow, okay, let's address that
there is a little bit ofmistrust, but let's educate you
(19:44):
as well, you know, as what thepros and cons of all the options
are.
SPEAKER_03 (19:50):
Do you think black women are suffering more?
Um because of that, you know,I'm I'm it it really I have to
ask that question because umbecause I'm truly curious.
I I don't know woman.
Um, do you think that becausethere is that mistrust uh with
the healthcare system that blackwomen are suffering uh more?
SPEAKER_00 (20:11):
I I do, I do, and or they're willing.
I shouldn't say that, butthere's a level of, okay, I'm
I'd rather just go this routeversus this, you know, I can
navigate, you know, sufferingthrough.
Um because there is that levelof, uh, I'm not sure.
(20:33):
I don't want to add anythinginto my body.
And when you break it down forthem and share with them that,
especially with bioidenticalhormone therapy, all I'm doing
is replacing a little bit ofwhat your ovaries aren't
naturally producing anymore.
That's all it is.
And it's almost like, you know,like it's like a wow, I've never
heard of it like that.
(20:54):
If that's all it is, you know,because explaining to them that
this is bioidentical, this issimilar in structure to what
your ovary naturally produces,it really makes a difference for
them be, you know, to be willingeven to take take the first
step, you know, versus it havingthis connotation that, oh,
(21:14):
they're treating me withhormones and their side effects
and all these different thingsthat could happen to me.
I feel like it really requiresjust breaking it down simply.
SPEAKER_02 (21:24):
And I can also imagine that if you know you're
hanging around with your groupof friends and nobody's doing
anything about this and is notinformed, then why would you go
out on a limb to, you know, dosomething that somebody that you
don't even know or looks likeyou is doing and you know, we
don't talk about it and it'sfine, and I'll get through it.
Because when I look around atyou know, my peer group, we're
(21:48):
all in, we're all like talkingabout that.
This is an important thing,probably because this is what I
do all day long.
This is what we do, right?
That's what I do all day long.
But I I know that if I didn'tsee people like me who or no one
was talking about it andeveryone was just suffering to
get through it, because thatwe've done that so many times
with so many other things thatit would be a hard sort of mind
(22:10):
to change.
SPEAKER_00 (22:12):
100%.
And I have a story for youbecause I had a very specific
patient who found me onInstagram.
I brought her into Alloy becauseI was like, look, we can't
communicate on Instagram abouthealth issues.
And so she came into you know,alloy, and we went through
absolutely everything.
She had a group of friends andthey were Buddhist, you know,
(22:34):
and she was black, but she hadher Buddhist group of friends,
and they all had told herhormone, she had prescribed to
what they prescribed through,and they had basically were like
anti-hormones.
And so it wasn't until shestarted to be like, okay, I'm
starting to feel miserable, andI'm starting to see Oprah's
talking about it.
All these different people aretalking about it.
And so now I'm gonna do myresearch.
(22:55):
So she took time to do herresearch while she was doing her
research.
She had her doctor start her onVIOSA, which is in non-hormonal
therapy.
But then by the time she came tome, she DM'd me, brought her
into Alloy.
We did a full consult where wewent through all her options,
you know, and she was ready.
She was ready and she said, I'mactually going to choose this
(23:15):
for me, because even though myfriend group isn't there, I want
to be able to plan for not onlywhat I'm dealing with now, but
also for my long-term health.
And she probably and it was avictory, yeah, for her.
SPEAKER_02 (23:29):
And she probably told her friends.
Yeah, there's a ripple effect onthe other side.
Yeah.
Yeah.
Yeah.
Um, okay, switching gears alittle bit.
Um, I read a New York Timesarticle recently that um black
women have been experiencingmore unemployment in the past
two years, that the workforcehit black women particularly
(23:52):
hard.
SPEAKER_01 (23:52):
Yeah.
SPEAKER_02 (23:53):
How does menopause intersect with race and
workplace inequities as it comesto menopause?
Because I was surprised by that.
And I know that you know, thewomen that are probably being
laid laid off in the federalworkforce have worked there
forever and are probably ofmenopause age.
And so it again, the workplaceis being, you know, in uh
(24:18):
discrimination, you know, inintentionally discriminating
with women in the workplace.
But can you talk about the sortof race and workplace inequities
as it's related to menopause forblack women?
SPEAKER_00 (24:30):
Yeah.
And so I think just as you said,I think in general, black women
are already navigating these,either whether it's pay gaps,
racial bias, they face an extraburden when it just comes to the
workforce in general.
But when you think about goingthrough menopause, and I've seen
this with my patients, you know,their symptoms, they affect
(24:51):
their concentration, theirenergy, their confidence.
And when that starts to happen,you really need a level of
workplace support, right?
In whatever way that looks like.
So I have patients who have toldme that they either are business
owners, they can't get off thecouch because of these symptoms.
They're just energy is depleted.
(25:13):
You know, they're running theirown businesses and it's just
like, I just don't have theenergy to do it.
I have other patients who, youknow, are responsible for
billion-dollar contracts, right?
And they are unable to, likethey're in meetings and their
confidence is affected becausetheir memory is, you know, they
have issues with their memory,concentration, and they are
(25:35):
really lacking confidence whenit comes to, oh my gosh, what is
it that I, you know, need to donow?
Because I really think that myboss is not going to fire me,
but they're just thinking mywork performance is poor and I'm
going to be in trouble with, youknow, at my work evaluation.
So I think when it comes toblack women in general and what
(25:58):
we're seeing with these federallayoffs, so I can't control
what's happening with thefederal government because
they're choosing to do like, orwe can't control what's
happening right now.
But I do think that when youlook at the workspace for black
women, they're even going to bemore impacted because you know,
(26:19):
if they're not getting the curefor some of the symptoms that
they're experiencing that areaffecting their performance,
right?
You know, without that workplacesupport, you're gonna have mixed
missed promotions, you know,when it comes time for promoting
somebody, if they're havingissues with concentration,
they're not gonna really be onthe top, you know, tier for a
(26:41):
promotion, reduced pay, youknow, and some of them cut back
from their careers, right?
You know, and that's the sadpart because, you know, I one of
my greatest joys is being ableto see some of these women, you
know, go from where they were,start hormones, and then they're
just like, oh my gosh, you know,I'm actually participating in
(27:02):
meetings, and I feel yeah, and Ifeel like I feel better.
And you know, all that lack ofconfidence that comes with you
know your symptoms, it goesaway.
And you know, I see patients andI'm like, you're a different
person.
So, so, so, so I think lookingat you know, black women, again,
(27:27):
0.5% on hormone therapy, youknow, to be able to like have
like you know, and a lot ofblack women have more physically
demanding, you know, jobpositions.
So this already sets them backto some degree, you know,
because 0.5% is a very low dose,low low percentage of black
(27:54):
women who are on hormonetherapy.
And as we know, this can besomething that's really helpful
in just restoring the estradiollevels and getting you back to
um a better performance, whetherit's mental clarity, you know,
and all the different thingsthat can contribute to, you
know, reduced performance.
SPEAKER_03 (28:14):
So the um access to healthcare uh is important, you
know, I'm hearing that over andover and over again here uh in
this conversation, so that theycan get the support that they
need.
I'm wondering as we think aboutemployers and the workplace,
because that's the space that wesit, right?
Um I'm wondering what roleemployers can play in reducing
(28:39):
those healthcare disparities.
So, you know, moving beyond, um,I don't want to say just um
healthcare benefits, becauseit's extremely important to have
those benefits to get the helpthat they need so that they can
get back to the workforce andperform at that at that peak,
right?
With the confidence, yeah,feeling better.
It's really important.
But what else can employers doum to play a role there in re in
(29:04):
in reducing those healthcaredisparities?
SPEAKER_00 (29:07):
Yeah.
And that is such a greatquestion because I think, yeah,
okay, awareness is one thing,but I think changing policies is
really where, you know, the thethe the you know, that speaks
volumes.
Okay.
And so when I think about um,you know, flexible scheduling,
you know, there may be women whohave really debilitating
(29:27):
problems with their sleep andmaybe just starting a little
later, you know, and and endinga little like having that
flexibility for scheduling, Ithink is is is one core aspect.
Um, if you have to wear auniform at work, having
breathable, you know, materialso that it's not something
that's gonna, you know, be worseoff for you if you are having
(29:53):
and experiencing the hot blushesum and uh you know, sweats,
having having material that'sbreathable that's that's one way
to look at it I think you know Ilook at temperature controls
like do patients have like do doum employees have the ability to
you know regulate temperaturewithin their spaces um and then
(30:14):
I think you know even looking atpaid time off for doctor visits
you know does that employeroffer time for patients to
actually you know get the carethat they need because I think
sometimes you're looking at oh Idon't want to take the time off
because I won't get paid for itbut then is there that time paid
off available um and then Ithink you know insurance
(30:37):
covering you know menopause careso that women can go over all
their options and know whattheir options are and then I
think it's important to knowthat okay if one course of
treatment isn't working let'smove on to another so that you
know women don't feel likethey're stuck in a okay I used
my one benefit or one whateverthat I get like but that is
(30:58):
something that's available youknow consistently so that you
know I think what I found isthat validation and options are
something that women like evenjust getting that it's like a
huge weight off their shouldersand they feel like more
empowered in this journey.
(31:19):
So it's not just okay you hadyour appointment here's your
treatment goodbye.
Right they need that um and thentraining managers because I
think sometimes managers okayyou can but what what are you
training them to be looking foryou know in some of the the the
women because I think what tendsto happen is if a manager isn't
(31:42):
isn't aware of what maybe whatsome of the what the lived
experience is of you know theirthe employees it's really hard
for the manager to be able toidentify and ask more questions.
SPEAKER_02 (31:57):
Yeah you know when they see something you know
within a patient likeconcentration they're not like
the assumption can always be ohyou know not working hard enough
not you know and so I think itwould be nice to be able to
train or efficient like it wouldbe imperative I shouldn't say
nice imperative you know formanagers to be trained to be
(32:18):
able to identify those are thoseare great those are all the
answers that we usually talkabout on why supporting women in
the in the menopause space isimportant.
I want to go back to somethingyou just said a few minutes ago
about you know start tryingsomething and then you got to
keep sometimes you got to tweakit.
You got to be experiment and yougot to get curious about what's
(32:41):
working for you.
And I don't know if I mean myexperience is that women are not
good at that I take theprescription and I just deal and
I would imagine that youprobably have to talk to your
patients and I don't know ifthis is a a black woman issue or
not but really figuring out whatworks for you might take a
minute.
(33:02):
And and and it takes some timeto figure it out and you might
have to experiment a little bitto feel really good.
But feeling good is just soimportant especially at the
stage of life where we'resandwiched between you know
taking care of our children andour parents and you know our
careers and all those kinds ofthings to feel crappy in the
(33:22):
middle of that is not helpful atall.
Can you speak to that a littlebit?
SPEAKER_00 (33:27):
Yeah no I I completely like understand what
you're saying about feeling goodand what I find with patients is
um it's so interesting becausethis is what I have to tell
them.
They come and they're like soconfused about okay do I do this
but then if I lock myself intothis then you know or should I
(33:49):
choose this and you know andthen if I lock myself into this
like they see it as a fixed onefixed solution.
Meanwhile this is like trial anderror and I tell patients this
all the time your body and yourgirlfriend's body are completely
different bodies okay so yourgenetics your body chemistry is
going to be different.
(34:10):
So what worked for her may notwork for you.
And I think changing the mindsetthat it may take a little bit to
get you to the sweet spot.
So we may start you withprogesterone only if you're an
early perimenopause after threemonths because that's usually
how long it takes to adjust toany form of like you know a new
(34:31):
hormone within your system rightwe all have estrogen receptors
in different parts and how thoseestrogen receptors respond, it
can take a minute you knowbecause it's again we have them
all over our bodies we maynotice some side effects we may
and again it takes your bodywhat a good few weeks if you
have side effects for them to goaway.
(34:53):
And so I think it's reallyimportant to understand that,
you know, okay we start withinthree months we're looking at
making tweaks if necessary andthen boom we go another three to
six months we need to maketweaks we do that if necessary.
So it's not a one size fits allit's very personalized.
And your symptoms the ones thatare the most burdensome are
(35:17):
different from somebody else'sso we will only know what works
for your body based on what youtell us and we try to tailor it
to again not only your symptomsbut your age your family history
your medical history right andyour allergies so there are a
lot of factors that come intoplay in determining where we
(35:39):
start and then also how we makeadjustments after three months.
I've had women who it takes ayear for them to get to a point
where you know they know thatthings work.
So that's where I always tellpatients that it's important to
be patient with your body andthat this is a journey.
You know we're we're it's not aone and done it's it's it's it's
(36:01):
a journey where we you knowrequire frequent check-ins to
see what modifications need tobe done.
SPEAKER_02 (36:07):
I think that's huge for all women to understand
we're all different.
SPEAKER_03 (36:11):
Yeah yeah my symptoms are different than
Kim's and yours and right um andwe all have comfort levels and
how we want to manage thosesymptoms and to your point our
backgrounds and our genetics andit's all different.
So I I love that you bring thatup because we sing that song
every time we gather with agroup of women we were just
(36:31):
saying that last night in thefireside chat and we were also
it's interesting you saidsomething earlier too that I
want to come back to um it'sit's interesting that you
mentioned community groups umbecause at the end of the
fireside chat last night umreally the conversation turned
to isn't this great that we haveeach other that we can we can
(36:53):
share ideas we can share what'sworking for one maybe have you
tried this and I think that'simportant because you don't know
what you don't know right oh Ididn't realize that that was
available so I'll I'll ask myhealthcare provider about that.
The the community groups and umsupport building that tribe is
really important.
And I know that there's researchthat shows that it will actually
(37:15):
lessen our symptoms just bythinking about it and being
there's you co-lead uh supportgroups, right?
Wellness support group.
And I'm wondering what you'rehearing directly from the women
in your support groups and I'malso wondering how that can help
fill gaps with the traditionalhealthcare systems.
SPEAKER_00 (37:36):
Yeah it's it's I mean they're powerful they're so
powerful uh we get you knowblack women from you know
different parts of the countryand um the one thing that I know
is that I hear women share aboutI thought it was just me.
Right always you know I thoughtit was just me.
(37:56):
And then I also see you know howto learn self-advocacy right so
one woman who maybe furtheralong in her journey and then
somebody else who's juststarting her journey they are
actually like wow you know Inever thought to ask my doctor
that and so you know we havewomen come back just as I shared
(38:17):
earlier wow next time you I comeback you're gonna hear that I'm
on hormones you know forsomebody who was not a believer
in them.
You know I had another patientwho was on hormone therapy and
she had a history of fibroidshad started some irregular
bleeding and they couldn't getit under control.
So they told her okay let's do ahysterectomy because she was 55.
And you know what she did?
She said you know what I want toknow what my other options are
(38:40):
you know and she came to thegroup and she asked hey I was
looking them up and a uterineartery embolization I looked at
and I thought about that.
Lo and behold there was somebodyelse who had a uterine artery
embolization in the group shecould share her experience and
just things to consider.
And it was such a moment of umuh like integrative support and
(39:04):
her feeling good about beingable to go back to her doctor
and share why she wanted thisyou know more empowered and so I
think you know learning thatself-advocacy is something that
I see in the groups and then Ithink it's like you know just of
course group validation you knowshared solutions you know women
(39:27):
come back and say okay well thisworked for me or I tried this
you know sugar that'snon-glycemic or you know it's
more expensive but this is whatreally helped me get you know my
um blood sugar control improvedwhen I chose to adjust my
nutrition you know and sothere's this sense of
(39:48):
sisterhood.
It's like I'm looking out foryou you're looking out for me I
want to help you understand whatworked for me with my skin
symptoms like I use this brand Iuse that brand and it helped me
again I'm just sharing knowledgethat I've gained and I think
that you know really fills thegaps that the traditional
healthcare system leaves open.
(40:10):
And they feel like okay yes Imay not have had a long
conversation with my clinicianbut I came to this hour support
group and I felt like wow thisanswered my question because I
could tell her what a uterineexactly was right explain it,
how it's done, what some of theside effects may be, you know,
and I'm not sharing this withthem as their doctor but just as
(40:33):
a source you know of you knowmedical information that they
may not necessarily get withinthat short visit with their
doctors.
And then they have thatinformation and they can then
take that to their healthprovider right yeah yeah so yeah
works both based I love thatbefore we move on I want to um
just can you please tell us howum our listeners can be a part
(40:57):
of those community groups yeahum so alloy at www.alloy.com we
actually have a um I'm gonnasend this to you we have um
event rights and we actuallysend them out um every for you
know and as long as you're onthe email list we can actually
send you one you can registerand then as long as you're on
(41:19):
the email list you'll you'll getthem you know every time they go
out and that way you'll knowwhen they are at least a week
before and we do them twice amonth.
So that allows women who aren'table to attend every month but
we have women who come everysingle time we have like a crew
of women who are you know whoare like these are my people now
(41:42):
and yep yeah yeah it feels goodto be a part of a community that
you're familiar with we all wantit we all want that right yeah I
want to feel connected and Ialso have younger perimenopausal
women like in their early 40swho actually come and they say I
am so glad I am getting to hearthis see this learn this so that
(42:05):
when my symptoms get worse rightit's just good to see women who
look like me who I can actuallybe like wow yeah I know what to
expect.
SPEAKER_02 (42:18):
That's fantastic.
Dr.
Dumbo we could talk for anothercouple hours um really
appreciate your um knowledgeexperience your um what did you
call it fire in your belly firein your belly yeah I love I just
I just love that but if youcould leave our listeners with
one key takeaway um what wouldwhat would you want to leave
(42:39):
them with?
SPEAKER_00 (42:41):
I would say don't normalize suffering I did that
you know and I ended up withdebilitating symptoms where I
actually started to cut down onmy shifts at work because I was
doing 24 hour shifts but don'tnormalize suffering you know
because I think you can it'svery easy to say oh my gosh I'm
getting older because I'm 50turning 52 and I was like okay
(43:04):
this is maybe just what happensas I get older you know and and
I normalized it to the pointwhere I you know I was you know
in emergency room but I justdidn't know what was going on.
So that is one thing that Iwould say do not normalize
suffering.
And then I I would also say youknow um you know if your
(43:26):
clinician is not being proactiveyou know in addressing your
symptoms and discussing all ofyour options because I think
it's really important for thereto be agency you know you you
have you you leave feeling witha sense of agency.
There are always other optionsand you can always give your
(43:48):
clinician you know umopportunity by maybe taking an
article with the 2022guidelines, you know, for
menopause, you know, hormonetherapy if you really are
considering hormones.
But I also say that if you'rereaching a wall, you know your
your story is not over likethere's always somebody else or
there is somebody else who wouldbe able to help you.
SPEAKER_03 (44:10):
That's great.
We always say you can divorceyour you can divorce your
divorce your done if you if youneed to yes and go find it's
okay.
SPEAKER_00 (44:18):
Yeah absolutely yeah absolutely so where can people
find you um I am at alloywomen's health or x it's
www.alloy.com excuse me my alloydot com so they can find me at
alloy and that's where I spendmajority of my time excellent
and you're on Instagram you knowyes I'm on oh that's right and
(44:41):
on Instagram at dr dot couldseyefantastic where I try to share
pearls show notes okay yeah I'mgonna go follow you as well yeah
okay wonderful before before wesign off we ask everyone what
the best piece of advice you'veever received has been what
would you say to that followyour gut you know follow your
(45:04):
internal like that internalvoice about what you may
experience or feel and know thatone door that may appear to be
closed there's another door opensomewhere else so I do that for
patients for other cliniciansfor myself I think it's really
(45:26):
like we have wisdom within usand we know.
SPEAKER_03 (45:30):
We do just we do and when we go against gut
oftentimes it doesn't work out.
So we need to listen to our gut.
Yeah yeah thank you for that andthank you so much for spending
this time with us and sharingyour expertise I'm sure we'll
have you back because there wasa lot that we didn't have an
opportunity to discuss.
But until we meet again go findjoin the journey.
(45:51):
Yeah absolutely thank you somuch take good care all right
bye bye thank you for listeningto the Medovia menopause podcast
if you enjoyed today's showplease give it a thumbs up
subscribe for future episodesleave a review and share this
episode with a friend.
Medovia is out to change thenarrative learn more at
(46:13):
medovia.com that's M I D O V I Adot com
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