April 26, 2025 ā¢ 41 mins
The Dusty Muffins are back to debunk the biggest menopause myth of all - that there's a universal treatment that works for everyone! Dr. Aoife O'Sullivan, Dr. Christine Hart Kress, and Dr. Rebbecca Hertel explain why personalized care is crucial during this life stage and how to find what works specifically for YOU.
In this empowering episode, you'll learn:š Must-read books to educate yourself about hormonal changesš¬ How to assess if your clinician truly understands menopause careš Where to find menopause-approved specialists when you need more helpš Why picking up the phone can be your secret weapon for better (and more affordable) care
The Muffins share:ā¢ Why identical twins might need completely different treatment plansā¢ Red flags that suggest it's time to seek a second opinionā¢ Their favorite resources for connecting with qualified menopause specialists.
With their signature blend of medical expertise and real-talk humor, they'll give you the confidence to advocate for the individualized care you deserve.
Remember: They're doctors sharing knowledge, not YOUR doctors - this episode gives you the tools to have better conversations with your own healthcare team about creating a menopause plan as unique as you are!
Subscribe for more straight-talking women's health advice that celebrates your individuality.
CONNECT WITH THE DOCTORS
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
In this empowering episode, you'll learn:š Must-read books to educate yourself about hormonal changesš¬ How to assess if your clinician truly understands menopause careš Where to find menopause-approved specialists when you need more helpš Why picking up the phone can be your secret weapon for better (and more affordable) care
The Muffins share:ā¢ Why identical twins might need completely different treatment plansā¢ Red flags that suggest it's time to seek a second opinionā¢ Their favorite resources for connecting with qualified menopause specialists.
With their signature blend of medical expertise and real-talk humor, they'll give you the confidence to advocate for the individualized care you deserve.
Remember: They're doctors sharing knowledge, not YOUR doctors - this episode gives you the tools to have better conversations with your own healthcare team about creating a menopause plan as unique as you are!
Subscribe for more straight-talking women's health advice that celebrates your individuality.
CONNECT WITH THE DOCTORS
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the Dusty Muffins where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause im perimenopause.
Whether you're curious, confused, or just looking for real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with the dash of
(00:26):
humor and a lot of heart.
Speaker 2 (00:27):
So pull up a chair and join the conversation.
Speaker 1 (00:30):
Before we dive in, Please remember, while we're doctors, we're
not your doctors.
Speaker 2 (00:34):
This podcast is.
Speaker 3 (00:34):
For educational purposes only and is not a substitute for
medical advice.
Speaker 1 (00:39):
We encourage you to partner with your own medical clinician
to address your unique health needs.
Speaker 2 (00:44):
This is the Dusty Muffins.
Speaker 4 (00:47):
Welcome back to the Dusty Muffins where menopause meets real talk,
good laughs, and absolutely know one size fits all nonsense.
Speaker 5 (00:57):
Because let's be honest, If menopause wear a T shirt,
it wouldn't come in a one size fits all. It'd
be a clearance rack mess of options that just don't
fit right.
Speaker 1 (01:08):
Some women breeze through it, and others feel like their
body went into a full on rebellion mode and guess
what both are normal? Today, we're breaking down why menopause
is not a one size fits all journey and how
to find what actually works for you.
Speaker 4 (01:24):
So grab your tea or coffee. We're diving in today.
We're talking about why it's not a one size fits
all approach when it comes to menopause.
Speaker 2 (01:34):
Right, ladies, you got it?
Speaker 6 (01:37):
Yeah, some movies march.
Speaker 2 (01:39):
All right?
Speaker 1 (01:40):
Do you want to start with introductions? Over here in
the snowy eerie, Pennsylvania. I'm doctor Recker Hurdle on boards
for fied Osthopathic Family is a physician and a certified
menopause practitioner in Pennsylvania.
Speaker 4 (01:56):
I'm Ifa O'Sullivan, a Board certified family physician and Menopause
Society certified practitioner. Coming to you from Portland, Oregon.
Speaker 5 (02:05):
Hi, everybody, I'm doctor Christine Harcress. I'm a Board certified
Women's Self Nurse practitioner and a Menopause Society Menopause practitioner,
and I'm coming.
Speaker 6 (02:13):
To you from Northern Virginia.
Speaker 2 (02:16):
All right, so yeah, go ahead, ey, you got something?
Speaker 4 (02:19):
No, I was just going to say Today we're going
to get into why. You know, For instance, I give
a lot of talks to the residencies locally here in
Washington and Oregon, and they usually give me like an hour,
a stingy hour, and I'm always like, am I doing
more harm than good? You know, I've just squashed things
(02:41):
into an hour because I think I leave those clinicians thinking, oh,
I can do this. I'll just tick a patch on her,
you know, and give us some progesterone. And we know
that every woman is completely different than the next, don't
we Like every case is so nuanced.
Speaker 2 (02:58):
Yeah, it is.
Speaker 5 (03:00):
I find that when I start, I start all my
visits in the same manner.
Speaker 1 (03:07):
You know.
Speaker 5 (03:08):
Obviously, I want to hear people's journeys and where they
have been, you know, what experiences they've had with other providers,
or if they've been on menopausal hormone therapy. What I'm
finding right now is that, you know, six months ago,
people were coming, women were coming because they couldn't get
anybody to prescribe. But what I'm noticing now is they're
(03:32):
coming because they feel like what they're on is not
quite right and they want some They want to be tweaked,
like they feel like it's not individualized that you know,
no one has looked at their whole picture, and so
you know, I always start out by teasing through their symptoms.
I love looking at that green climac Ic menopausele score
(03:55):
and have women score out their symptoms and then you know,
really go through and figure out what symptoms are really
bothering them, because you know, whether you're tweaking someone or
new starting them, you always start with what hormone needs
to be addressed by, where the symptoms are, if they're
low estrogen symptoms, progesterone or testosterone, because ultimately what we
(04:20):
want to do is make women feel better and relieve
those symptoms.
Speaker 3 (04:25):
Yeah.
Speaker 1 (04:25):
Yeah, and I see I see a lot when and
we're just talking about menopausals and one size fits all
and we'll do another one on perimenopause.
Speaker 3 (04:34):
So I find that they are patients that will.
Speaker 1 (04:38):
Come in and they're like que on five patch and
this and that's where they were from, like the gate
or a Comby patch, and they're coming because either they're
bleeding their estrogens too high because they were just kind
of put like on this you know, this prescription that
I think that these you know practitioners were just taught
and that's how they were taught to do it. So
(04:59):
in one way, specter like, I'm so happy that they
gave it to you, But in the next one, you
were just like, ah, okay, you know, we're just we're
gonna have to fine tune that and tweak that a
little bit because that doesn't work for everyone, right, I.
Speaker 4 (05:12):
Agree, Yeah, so you get I'm the same. I really
feel like over the last few months, I've been seeing
so many of those particular patients who are on something
and then they go back to follow up and their
clinician has kind of maxed out on what they know,
which is understandable, right, because we don't get any training
(05:33):
in this, and so that clinician has probably thought, oh
my god, this is all missing from my training. I'm
seeing it all over social media. People are talking about it,
my patients are ask me about it. I need to
learn something, And so they do their best, and then
they get to a point where unless you've had a
ton of experience, or unless you've done a particular course,
(05:53):
you're just not going to know what to do next,
you know. And I have had those women come in,
who are you know in their late fifties, haven't had
a period in many, many years, and we're slapped on,
you know, a seventy five microgrant patch and are now
beving or a poor perimenopause. A woman who's in her
(06:14):
early forties and is on this twenty five microgrand patch
and it's not doing anything for her, you know. So, yeah,
that's funny that we all feel like we've been seeing
a lot of that. It must mean that clinicians are trying.
Speaker 1 (06:28):
Right, yeah, right, which is good, which is good, you know,
but you're just like, okay, now, now what do we
do with this? And I think, you know, and let's
maybe let's go back a little bit and talk about,
you know, why does this vary for every woman? You know,
let's kind of take it back and to why at
least we all take an individualized approach, you know, is
(06:48):
it do we take genetics into a fact, like, you know,
do you guys ask your women like, hey, what is
your what was your mom's menopause?
Speaker 2 (06:57):
What about your aunt?
Speaker 1 (06:58):
What about you know, at least at least a question
of it, you know, if they talked about it, do
you find that there's a correlation there at all?
Speaker 2 (07:06):
At least for some symptoms.
Speaker 4 (07:09):
For me, nobody knows. I mean, this is not something
that's ever been spoken about in any family. I think
there's the rare patient that you come across that says, oh,
my mom went into menopause when she was thirty seven,
you know. But other than that, I find most of
my patients don't know what their mom or their aunt
(07:30):
went through. Yeah.
Speaker 5 (07:32):
I think that's a good point. And you know, I,
you know, I counsel women. You know, this isn't your mother's,
sister's daughter's friends menopause. You're not going to have your
menopause experience is not going to be like like someone
else's because I want to remove that expectation that they
feel like, you know, they're not doing it right or
(07:54):
they're worse than someone else. But you know, I haven't
found that that women model their model their mothers at all.
And you know, in the in you know, the cases
that I you know, talk to women, and you know,
and that's some of that might be my own personal
bias because my mom went through menopause at forty one
(08:15):
and I'm sitting here at fifty theory still trying to
figure out if I'm going to puzzle because I don't
think I'm quite there yet. My lab work says I'm
not quite there yet, and so I used to think,
you know, like thirty years ago, I used to think, oh, you're.
Speaker 6 (08:29):
Going to do it just like your mother.
Speaker 5 (08:31):
And now I think, just based on my personal experience,
I I like, I now just have this thought in
my head that you know, and just from talking to
people that it really it doesn't It doesn't really run
in lineage, is what I'm noticing. But I'm also I'm
also fearful of, you know, pointing that out because I
(08:52):
don't want them to think, you know, I just want
them to have their own experience and not be biased
or tainted by other people had.
Speaker 2 (09:02):
Yeah.
Speaker 1 (09:02):
Yeah, I feel like I get more so the point
like both of you where my patients don't really know.
But I do have some that have said, hey, you know,
my mom went through it like forty five, or my
mom had really horrible hot flashes and really terrible mood,
and you know, this started for her about the time
(09:24):
that this is starting for me. And sometimes that helps
them understand. And I had that same discussion with them.
Your menopause in your journey is yours, but sometimes it
helps validate what they're maybe they're going through because you know,
mom did as well, or you know, or if they
had admomal bleeding or fibroys or whatnot. Now, what about
(09:47):
the differences in even just ethnic and racial differences with
menopause experiences.
Speaker 4 (09:54):
Yeah, because there's a study going on across America, the
SWAN Study, the Study of Women's Health cross the Nation
that's been going on since the nineties.
Speaker 6 (10:04):
I think yep, ninety six.
Speaker 4 (10:07):
Yeah, and so those women were perimenopausal I think when
they entered that study. And it's a nice slice through
America when you look at the women who are involved
in it. They are not just white American women, which
so much of any research that we do have on
women in America is based on and so we do
have loads of information from that, and we see that
(10:29):
African American women in general, especially when it comes to
vas of motor symptoms, their start earlier, they're more severe,
and they go for longer, for more years. And we
know how dangerous for its motor symptoms can be for
our brain and our heart.
Speaker 5 (10:49):
And the interesting thing that I was just listening to
a lecture this week is that they're least likely to
seek care because their mothers and their aunts and their grandmothers.
Speaker 6 (11:04):
Didn't talk about it.
Speaker 5 (11:05):
And so I think that is a really interesting point.
And in that particular lecture, they you know, the point
of it was is that as providers, we should be asking,
you know, the premenopause counseling and opening up the door,
because if we don't open up the door for women
to feel comfortable talking about it, they're likely not going
(11:27):
to and then they're going to suffer for much much,
much longer than what's necessary.
Speaker 1 (11:33):
Yeah, and I think it's it is, and it's very
important to you know, to also understand that when you
take care of a diverse population of women that you
it's it's I think it's even more important to open
up that conversation so that way your women know that
they can talk to you, that you don't understand that
(11:54):
there are different racial and ethnic symptoms and experiences that
are had and that we're not going to generalize their
experience either, and we're not going to you know, it's
very it's as much important as our next female patient.
And so you know, like our our our Asian women
(12:18):
and bone pain and and even the Latino population has
has more severe hot flashes and night sweats and those
can last longer as well, or smanitization where it's more
muscle pain and and body pain as well. So it's
just really important for our listeners to understand that, you know,
there there are very much differences in the way menopause
(12:42):
is experienced in women, and that's not a one size
fits all so and that's very important for practitioners to
understand that and to and to address it.
Speaker 6 (12:54):
Yeah, go ahead.
Speaker 4 (12:56):
If oh, I was just gonna say, I was trying
I was thinking mac on that ground from the Swan
study and I think it was I haven't you a
Hispanic women were affected the most when it came to
basic motor systems. Caucasian women were in the middle, and
then American, Chinese and American Japanese women were affected the least,
just when it came to basic motor symptoms. That doesn't
(13:17):
like any other menopausal symptoms. But I just find that
so interesting. You know, we don't know if it's genetic,
dietary and a difference in the quality or the availability
of medical care like it's so righting, probably multifactorial.
Speaker 2 (13:36):
Very much so.
Speaker 5 (13:37):
And the and the thing I thought was really interesting
is that you know, Hispanic women will peak in late
perimenopause with their symptoms and then by menopause they're over.
And then Chinese women their symptoms especially beaso motor or
(13:59):
highest post menopause. And then there was in that same
lecture they were talking about that because of the high
soy intake among Japanese women, that only about fifty percent
of that of women will actually have any basomotor symptoms,
and that there's peak just tiny little bit, but the
(14:19):
lowest of all the ethnicities in the perimenopause, late perimenopause
and then postmenopause they're not having problems. And that then
that's frightening about that is that a lot of women
don't seek care if they're not having beasomotor symptoms. But
you know, Asian women are so much they're smaller, smaller structure,
(14:41):
smaller bone frame to see osteoporosis and osteopenia, and they're
not seeking care because they're not miserable. So I think
that is, you know something, That's why it's just so
important for clinicians to ask and and then to realize
that everyone experiences their symptoms at a different you know,
(15:05):
at different time intervals.
Speaker 1 (15:07):
Yeah, and I find it very important when I'm educating also,
you know, different different women that I take care of
that I let them know that exactly what we just said.
Speaker 2 (15:17):
And you know, whether it is.
Speaker 1 (15:19):
A Latino woman, a black woman and woman of color,
or an Asian woman, I tell them. I give them
all of that information. And almost always they're like, I
never knew. I just thought it was a little bit
of hot flashes, and I'm like, no, those are really
important for you to take care of.
Speaker 3 (15:36):
Those are really you know, they affected your brain and
your heart, and so you know, they really appreciate too
that a your a just discussing menopausem that it is
a one it's not a one size fits all. But
then you're also coming back to like, I see you
as an individual and that you have different risk factors
because of that, and we need to talk about them.
Speaker 6 (15:55):
Right and depending on you know, how they present. You know,
it gives you.
Speaker 5 (15:59):
Like age of you know, where you would start in
terms of hormone therapy, because you know those super flashers
that are have in tons of hot flashes that are
like the media where they're soaking wet in bright red
are going to need a higher dose of menopausal hormone
therapy than someone who says, my hot flashes really aren't
(16:22):
that bothersome You can start them much lower, so you know,
looking at you know, their symptoms and then being aware
of you know, hey, you know they may start out
not bad, and then when I give them a little
hormone therapy, their hot flashes may get worse as they
make that transition through so and being. And I think
(16:45):
one of the things women need to realize is, you know,
it is absolutely normal to be on multiple different doses
throughout there.
Speaker 6 (16:55):
Why we're figuring it out different routes. Try them all.
Your insurance will pay for almost all of them.
Speaker 5 (17:01):
A little tricky on that fem rong, but you know,
try it out and find out what works for you.
And you know, I think people are afraid to say
I don't like it, say I don't like it, because
whatever you pick, you can you know, it's the next
forty years. So let's let's experiment and figure out what
which one works for you. And you know, if you're
(17:23):
still having symptoms, it's okay to go up on the dome.
Speaker 1 (17:27):
Yeah, and our receptors right not everybody's receptors work the
same way, So you could be great at a point
h two five depending on your receptors and how saturated
they get and some don't, or the route and how
your skin absorbs or your gut absorbs, and and so
that is another reason you know this one size fits all,
(17:49):
because everybody's receptors are different, and where your body decides
it wants to take the estrogen progesterone testosterone first, right,
you know, you might want it in your vagina, but
your brain may take it first or vice versa.
Speaker 3 (18:04):
So so true.
Speaker 4 (18:07):
You mentioned the SOI in Asian women's diet, Christine, So
that kind of brings us on to lifestyle factors, doesn't it,
Because that SOI has phyto estrogens in it, so plant estrogens,
and if you eat a lot of plant estrogens, they
can definitely help with Like we do see dietary differences
(18:30):
in women's and what symptoms they have and how, and
we see a difference depending you know, like if you
are having terrible hot flashes and you are able to
lose weight, now it's very difficult to lose weight in perimenopause.
You're having hot flashes, your sleep is obviously disturbed. But
if you are able to lose weight, we do see
(18:51):
that your hot flashes improve, you know, so an exercise
can help as well. So lifestyle, Will we talk a
little bit about lifestyle factors.
Speaker 5 (19:00):
Yes, yeah, you know, we were talking about you know,
wine a few minutes ago, and you know, it's you know,
it's a sad, sad sight, but at least for me,
I live in the middle of wine country. I think
I've said this before. I really don't have a wine problem,
but I do enjoy it. I used to enjoy wine,
(19:21):
and you know, I'm finding now that I metabolize it
much differently a glass of wine. I might as well
have drank the bottle of wine, because it goes to.
Speaker 6 (19:30):
My head, you know, very very rapidly. I don't sleep.
Speaker 5 (19:34):
I have hot flashes all night, and you know, and
you know that definitely, you know, you know is a factor.
And you know, of course the surge in general has
you know, put forth that you know, smoking and alcohol
are just as dangerous and you know for cancer rous
and so alcohol and then highly refined processed foods and
(19:59):
sugar that's also going to be a problem for your
menopausal symptoms as well.
Speaker 6 (20:06):
As your metabolic health.
Speaker 4 (20:08):
Yeah, anything that's inflammatory, right, we tend to really overreact
to things that we used to be able to tolerate
and we're inflammatory, like sugar and alcohol. But I really
think that going through the menopause transition and that lack
of estrogen on has such an effect on our liver.
(20:30):
Like we see what happens to our cholesterol production that
really ramps up, and the liver is integral to so
much metabolism. When it comes to alcohol as well, you
have to wonder is that the link you know, that
our livers are no longer able to metabolize that alcohol properly.
(20:50):
And then I don't know if you guys see this
a lot as well, but I have it and I
see it a lot in patients. Is that mast sell
destabilization that occurs and people will say they get that
flushing a lot certain foods and alcohols, And you know,
I think roseation is probably tied into that a little
bit as well. And all these things that we don't
(21:13):
one hundred percent understand, but obviously our hormones are so
involved and integral in those processes and we start to
get it. Then during the menopause transition and it just
makes everything so much more miserable.
Speaker 1 (21:29):
Mm yep, yes, And I think you know, there comes
that important discussion of you know, good lifestyle habits and
not smoking, and you know, minimal alcohol or no alcohol,
good sleep, you know, all of those things that we
really should be doing, you know, in our twenties and thirties,
(21:50):
and which would you know, it'll be interesting as maybe
that shift changes, to see how this perimenopause and menopause
transition will shift.
Speaker 2 (22:00):
Will it shift?
Speaker 1 (22:01):
Will they have a better perimenopause and menopause if those
lifestyle changes are are it's something that they are taking
on earlier in life, It'll be It'll be interesting.
Speaker 2 (22:11):
You know, we.
Speaker 4 (22:13):
Need the research we do because we see it ourselves
and we see it in our patients. Right that once
we are able to start working out, if we're able
to make changes and get some sleep, Yeah, things do
turn around, don't they. Like our lifestyle factors are so important,
not just the hormones. But I feel like a lot
of us go around so exhausted and kind of in
(22:35):
this inflammatory state that even our adrenal glands, which produce
testosterone on a daily basis, probably aren't functioning that well.
You know, and when you are getting your sleep and
you're feeling better and you're in a less inflamed state,
you're pumping out more testosterone which can get converted to
estradile and so just overall feel better and healthier evenly.
Speaker 1 (22:58):
Right, And that test goes up, and then you know,
maybe some other things are wanting to happen a little
bit more.
Speaker 2 (23:04):
Often too, because you're getting your sleep and you're you're getting.
Speaker 4 (23:09):
Yeah yeah, have energy, yeah.
Speaker 1 (23:12):
Yes, yeah, you want to be intimate with your partner,
you know, or yourself or whoever, and so it all
that all plays a part in that, you know, and
I think that so you know, lifestyle factors, but under
health underlying health conditions too, right, So making sure that
you're managing your thyroid disorders and and your diabetes or
(23:36):
your impair fast and glucose, or you know, other autoimmune
diseases like rhumatured arthritis and things like that, because those
can all flare and get wonky too as you're going
through that transition. And so it's important that a. I
think that either your indocrinologist or your rheumatologist or your
you know, primary care provider is also understanding that maybe
(23:57):
there'll be some changes as you're going through through this
menopause transition, so that they also need to understand that
and make sure that you know, you may see some
some changes where you'll need to tweak some medications or
or that maybe you know you're fast and glucose is
going to be getting a little bit worse when it
(24:17):
was under control and now it's not in control.
Speaker 5 (24:20):
So yeah, And I think the other thing too is
women with the history of pcos or infertility, if they
have spent a lot of time in their earlier years
skipping cycles. I think, you know, that's one thing for
them to realize, you know, is that if you went
a lot of years without ovulating, then you didn't you know,
(24:44):
you still have a lot of follicles, and so you
may go through menopause much later. You may be that
five percent that goes through menopause after age fifty five.
And then for those women, you know, you know our
infertility and our pcostions, those are those are classically associated
with low progesterone, and so a little bit of progesterone
(25:07):
often will help women early in the perimenopausal period, and
that's all they need is to replace that progesterone. But
I think you know people, you know women, you know
you never know when you're going to go through menopause,
but you breastpect for a long time, you had lots
of pregnancies. You may wait and go a little bit
later than other people who've been marching right along have
(25:29):
a monthly menstrual cycles and ovulations.
Speaker 1 (25:32):
Yeah, yeah, what about the problem with a one size
fits all approach. Let's kind of move on to that, Like,
you know, some outdated medical guidelines maybe with some doctors
are still saying to patients.
Speaker 2 (25:43):
Let's talk. I know, we could have a whole thing on.
Speaker 1 (25:46):
That, some misinformation at myths, maybe some of our favorite
ones there, and you know how maybe how menipause symptoms
are still being overlooked. So maybe let's start with some
some things that some of some docs are still saying
to our patients. You know, what are your a couple
of your favorite things about the outdated medical bindlines for practitioners.
Speaker 4 (26:10):
Oh my gosh, most there's a couple that drive me bonkers.
One is you're still having periods, so you cannot be
you cannot take hormones, which makes no sense because we
all know the most symptomatic period is when you're perimenopausal.
(26:31):
Once your postmenopausal, your symptoms will often taper off over
a few years. So when you really need that help
to carry on a normal life and keep your job
and your relationship and your marbles is when you're perimenopausal often.
And then yeah, so that's a big one. So you
(26:52):
have to be menopausal to have hormones right waited out.
Speaker 1 (26:56):
Sorry, this is just part of life.
Speaker 5 (27:00):
And you know, in that same you know, in that
same breath, I have been hearing an uptick of providers
telling patients, well, you're still having a period, so you
can't you can't have any hormone deficiency.
Speaker 6 (27:13):
Everything's normal, it all looks, it all looks.
Speaker 2 (27:18):
Normal to me, It all looks you know.
Speaker 1 (27:20):
And I have to tell you I had a you know,
one of both to that point. I had a patient
that had such horrible GSM and vaginal dryness that that
going to the bathroom was painful to use. Tis shoot
and her whether it was a g one and it
doesn't really matter who it was. Told her, I'm sorry,
(27:43):
you're still having periods. I can't help you, not even
vaginal estrogen. And I'm just like, you know, how when
you feel like sandpaper and you can't even you know,
clean yourself up after you go to the bathroom because
it's so dry and tender and friable. I'm just some
like how it baffles my mind how anyone can say.
Speaker 4 (28:10):
Hard to try and find out where this comes from? Right,
It's like if you were to ask that clinician one
more question, just where did what are you basing for?
Speaker 2 (28:22):
Which book? Where did you learn? That?
Speaker 4 (28:25):
They won't be able to tell you, because it's literally
this myth that floats around. But the only thing I
can trace it back to is the Straw Guidelines, which
I think we mentioned in a previous episode, which were
developed for research purposes to categorize women into whether they
were menopausal or not menopausal or not. Yeah, and it
(28:46):
kind of categorized the different stages of perimenopause, the menopause
transition overall, and you know, it quite clearly says the
first stage is where your periods get a little array,
and then the second stage is where they get more irregular.
And I honestly think that's where all this comes from.
Because people think this is some type of like scripture
(29:13):
that is not how women work. That's not how any
of my patients work. I don't know who they were
basing it on, honestly, but I mean, I have so
many patients who are riddled with every single symptom. I
say to them, I don't know how many of these
are due to perimenopause, but we can start you on
hormones and see they come back so much better. So
I have my answer. And yet they will tell me
(29:35):
their periods haven't changed at all. So this is really
a myth that we need to get past and is
a barrier to care for patients.
Speaker 2 (29:44):
It's huge. It's a huge barrier to care this.
Speaker 1 (29:48):
Misconception that menopause is natural and to just deal with it.
And how many times have we said, well, losing our
eyesight is too, you know, and we wear glasses and
we get readers, and there's.
Speaker 2 (30:00):
So many things that happened. Erect dysfunction is normal. You're right,
you are right.
Speaker 4 (30:08):
Your uterus falling down through your vagina is normal. But
we fix these things. We help them, We don't let
them suffer.
Speaker 2 (30:16):
That's a good point. It's good point.
Speaker 1 (30:20):
Yes, I'm not like, you know, We're not going to
be dragging our uses on the floor, you know.
Speaker 5 (30:25):
So I didn't have I picked that up, and I
did have a lady I did see.
Speaker 6 (30:31):
A ninety four year old came into my office.
Speaker 5 (30:33):
This is when I was in private practice, and she
kept telling me that something fell out and I was like, hmm,
I'm like really falling out. And she sat down on
the exam table and kid you not, the entire uterus.
I saw her inside out cervix. I was like, oh,
bless your little heart, it really is falling out. And
so we pestered herd nothing back in and got her
(30:56):
some help. But poor little thing.
Speaker 1 (30:58):
I did thapse a little old woman because all that
stuff is yours.
Speaker 2 (31:05):
You know.
Speaker 6 (31:06):
That was completely natural.
Speaker 4 (31:08):
That's right, that's not weak and us.
Speaker 2 (31:14):
It's just part.
Speaker 1 (31:15):
It's just part of aging, right, Like that pelvic floor
just gets.
Speaker 6 (31:22):
The lady was carrying her uterus in her underwear.
Speaker 5 (31:25):
Oh my god, it was like a ten centimeter uterus.
Speaker 2 (31:31):
That thing is that. That was ninety four. She had
a big one.
Speaker 5 (31:36):
But you know, I think one of the things that
you know for patients to know that their symptoms are
probably being overlooked is when you start doing the ologist march,
meaning that you're going to the rheumatologists for your joint pain.
You're going to the orthopedist for your you know, for
your frozen shoulder, the e n T for the ringing
(31:57):
of the ears. And so.
Speaker 6 (32:00):
Yesterday I was with a group.
Speaker 5 (32:02):
Of women and that you know that they were reporting
that they were being sent to all of these specialists
and they were they were giving pain medications and antidepressants
and you know, basically by their primary who just haven't
been trained. You know, we're just treating each symptom one
at a time and then sending it all out for
referrals because there just isn't enough education to understand. And
(32:26):
you can't blame providers because I was one of those providers,
Like I couldn't figure out why the anxiety and the
plantar fasciitis and you know, the joint pain and the
harp palpitations were how they could possibly be you know
related if you're not taught perimenopause and if you're not
taught menopause. But for patients, that's your ding ding ding
(32:49):
that it's that you know, stop, find yourself someone who
can look at your hormones and you know, then decide
if you need to move forward with the rest of
your thousand referrals.
Speaker 2 (33:05):
Yep, yep, absolutely.
Speaker 1 (33:09):
Okay, So let's talk about some personalized approaches and what
actually works.
Speaker 2 (33:12):
So hart and non hormonal options, we've talked about that.
I think, well, there's dinosaurs on the back.
Speaker 6 (33:20):
Hold on, I know, I was.
Speaker 2 (33:23):
All right, you girls take over, let me go turn
off my dinos.
Speaker 4 (33:26):
Okay, So personalized approaches, what actually works? So yeah, I
think we've kind of talked through some of these. You know,
our options for treatment are either hormonal or non hormonal.
Diet as in, you know, there are certain things that
we need to change in our diet as we go
(33:49):
through this menopause transition. We just can't keep eating like
we did in our twenties and thirties because our bodies
responding to these foods differently, like these ultraprocessed foods, a
high added sugar, foods, alcohol, yep, things are making putting
us into this really inflamed state, and it's causing and
(34:12):
our joints working. Yeah.
Speaker 6 (34:15):
Absolutely, And.
Speaker 5 (34:19):
I think it's important on the treatment that you have
a that you seek a provider who offers you all
the options because you need you you are in charge
of this journey and you need choices, and you deserve choices.
So if you have someone who says you can only
be on X, then that poses a question or all
(34:43):
the other things contra indicated or is this the only
thing that you prescribe? And so, you know, I think
women really need to have a plan, and you know,
but providers need to present all of the options and
let the patient decide. It's you know, we don't need
to be the one that decides because in the end,
the only thing that matters is one, is there any
(35:04):
absolute contraindications?
Speaker 6 (35:06):
In two? Is it something that's.
Speaker 5 (35:07):
Going to work with their lifestyle that they can actually
manage and they'll they'll do and they feel good about
doing those things.
Speaker 1 (35:17):
No, absolutely, And I think you know, the last few
things is that there are also other things that women
can do to help ease some of their symptoms, and
especially if they're not ready to do hormones or they can't.
I want to be clear that you know, when you're
losing estrogen, you got to replace it, but you can
(35:39):
choose not to replace it, right so, and not just estrogen,
but estrogen progesterone to stosterone.
Speaker 2 (35:46):
However, there are still there are a lot of options
that women do choose.
Speaker 1 (35:49):
And I was talking with a colleague who actually does
acupuncture and had said that, you know, she was treating
someone who couldn't do hormones and it really did get
rid of their hot flashes and it was really helpful.
So you know, when we think about certain supplements or
mindfulness and CBT and you know, therapy and things like that,
(36:10):
that there are there are other options out there while
you're trying to figure this out, or if you're just
not sure or you know you can't, or if you
just choose not to. Because we do have women that
just choose not to, and that's okay too, as long
as you know they have all the education that they need.
(36:30):
That there are also other you know, I guess alternatives
as well to help mitigate some of these symptoms.
Speaker 5 (36:38):
Absolutely, and you know, I you know the great thing
about being telemedicine right when you say what supplements you're
you're on and the patients say hold on a minute.
And it always makes me nervous when the supplements come
over in rubber made containers or we all travel to
(36:59):
the cabinet and there's they just keep coming out and
I'm like, and a lot of them, I'm like I've
never even heard of, because I think a lot of
people hear things on social media and they you know,
try this, try that, And so you know, women are
taking a lot of supplements and they may or may
(37:19):
not be useful for them, and they're spending hundreds and
hundreds of dollars and I think, you know, my best
advice is get your new you know, get your ferretin,
your B twelve, your vitamin D. You're foll late, get
them checked. Are you know do you have a deficiency?
Because if you don't, don't supplement it. Use food because
(37:41):
you don't know what all the interactions are of all
of the medications. And I mean, there's no point in
taking it if it actually isn't solving a problem that
you have, So be adding problems for all you know.
Speaker 1 (37:54):
That's that's right, that's right, and replacing your home runs
is they're now medications. When we talk about being natural, right,
we have natural options and so we want to fix
those things that aren't you know that you are having
(38:14):
that are declining, and if that's what you choose to.
Speaker 2 (38:18):
Do, but I don't.
Speaker 1 (38:19):
I always just tell my women, you know, I'm gonna
give you all these options I don't want you to
be afraid that it's not natural.
Speaker 6 (38:26):
Yeah, like erect right, so exactly, all right?
Speaker 2 (38:31):
Any other key takeaways?
Speaker 4 (38:33):
Yeah, I have some takeaways ready for us. So I
would say Number one, educate yourself. We always we've mentioned
a few times some good books. You know, Estrogen Matters
is always a great one, and it really goes in
depth into all the hormones and the safety of them,
so it takes away that fear. And if you read
(38:53):
that book, you're probably going to know more than ninety
percent of clinicians in this country about your hormones. Number two,
talk to your own clinician and see where they lie
with their knowledge of hormones and whether or not they
could get you started on them, because even to get
started will answer a lot of your questions, and then
(39:15):
you know, maybe they're going to learn with you, maybe
they're open to that. Some are. But if you get
to the point where you feel like you've plateaued and
you are just not on the right dose for you,
but you know so far things have really improved and
you know you just need to go a little bit further,
then if your clinician's not going to work with you,
(39:36):
I think the only thing to do really is to
go looking for more help then, you know, and I
suppose the list that we use. We always direct people
to the Menopause Society where you can find clinicians who
are certified. Doctor Mary Claire Hafer has a list of clinicians.
Speaker 1 (40:00):
Other listen my two main ones, I would say, yeah, yeah,
and again call call, call them if you can make
a call for when you do find one, and ask
how they work and how they prescribe and if they prescribe,
and what our thought processes. That can save you a
little bit of time and money as well, because not
(40:20):
everyone practices the same even though they're certified.
Speaker 2 (40:26):
So that's it. That's a big thing. Hopefully that will
change over time.
Speaker 4 (40:29):
But yeah, I agree, And we share some wonderful information
on our social on our accounts and social media crents.
So if you're employing these podcasts, please subscribe and lead
review and follow us on social media. And our next
episode is coming up soon and it's going to be
all about the most common questions women ask at the
(40:50):
M Factor screamings, So we'll see that all right, Bye everyone, Hi, everybody,
Welcome to the Dusty Muffins where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause im perimenopause.
Whether you're curious, confused, or just looking for real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with the dash of
(00:26):
humor and a lot of heart.
Speaker 2 (00:27):
So pull up a chair and join the conversation.
Speaker 1 (00:30):
Before we dive in, Please remember, while we're doctors, we're
not your doctors.
Speaker 2 (00:34):
This podcast is.
Speaker 3 (00:34):
For educational purposes only and is not a substitute for
medical advice.
Speaker 1 (00:39):
We encourage you to partner with your own medical clinician
to address your unique health needs.
Speaker 2 (00:44):
This is the Dusty Muffins.
Speaker 4 (00:47):
Welcome back to the Dusty Muffins where menopause meets real talk,
good laughs, and absolutely know one size fits all nonsense.
Speaker 5 (00:57):
Because let's be honest, If menopause wear a T shirt,
it wouldn't come in a one size fits all. It'd
be a clearance rack mess of options that just don't
fit right.
Speaker 1 (01:08):
Some women breeze through it, and others feel like their
body went into a full on rebellion mode and guess
what both are normal? Today, we're breaking down why menopause
is not a one size fits all journey and how
to find what actually works for you.
Speaker 4 (01:24):
So grab your tea or coffee. We're diving in today.
We're talking about why it's not a one size fits
all approach when it comes to menopause.
Speaker 2 (01:34):
Right, ladies, you got it?
Speaker 6 (01:37):
Yeah, some movies march.
Speaker 2 (01:39):
All right?
Speaker 1 (01:40):
Do you want to start with introductions? Over here in
the snowy eerie, Pennsylvania. I'm doctor Recker Hurdle on boards
for fied Osthopathic Family is a physician and a certified
menopause practitioner in Pennsylvania.
Speaker 4 (01:56):
I'm Ifa O'Sullivan, a Board certified family physician and Menopause
Society certified practitioner. Coming to you from Portland, Oregon.
Speaker 5 (02:05):
Hi, everybody, I'm doctor Christine Harcress. I'm a Board certified
Women's Self Nurse practitioner and a Menopause Society Menopause practitioner,
and I'm coming.
Speaker 6 (02:13):
To you from Northern Virginia.
Speaker 2 (02:16):
All right, so yeah, go ahead, ey, you got something?
Speaker 4 (02:19):
No, I was just going to say Today we're going
to get into why. You know, For instance, I give
a lot of talks to the residencies locally here in
Washington and Oregon, and they usually give me like an hour,
a stingy hour, and I'm always like, am I doing
more harm than good? You know, I've just squashed things
(02:41):
into an hour because I think I leave those clinicians thinking, oh,
I can do this. I'll just tick a patch on her,
you know, and give us some progesterone. And we know
that every woman is completely different than the next, don't
we Like every case is so nuanced.
Speaker 2 (02:58):
Yeah, it is.
Speaker 5 (03:00):
I find that when I start, I start all my
visits in the same manner.
Speaker 1 (03:07):
You know.
Speaker 5 (03:08):
Obviously, I want to hear people's journeys and where they
have been, you know, what experiences they've had with other providers,
or if they've been on menopausal hormone therapy. What I'm
finding right now is that, you know, six months ago,
people were coming, women were coming because they couldn't get
anybody to prescribe. But what I'm noticing now is they're
(03:32):
coming because they feel like what they're on is not
quite right and they want some They want to be tweaked,
like they feel like it's not individualized that you know,
no one has looked at their whole picture, and so
you know, I always start out by teasing through their symptoms.
I love looking at that green climac Ic menopausele score
(03:55):
and have women score out their symptoms and then you know,
really go through and figure out what symptoms are really
bothering them, because you know, whether you're tweaking someone or
new starting them, you always start with what hormone needs
to be addressed by, where the symptoms are, if they're
low estrogen symptoms, progesterone or testosterone, because ultimately what we
(04:20):
want to do is make women feel better and relieve
those symptoms.
Speaker 3 (04:25):
Yeah.
Speaker 1 (04:25):
Yeah, and I see I see a lot when and
we're just talking about menopausals and one size fits all
and we'll do another one on perimenopause.
Speaker 3 (04:34):
So I find that they are patients that will.
Speaker 1 (04:38):
Come in and they're like que on five patch and
this and that's where they were from, like the gate
or a Comby patch, and they're coming because either they're
bleeding their estrogens too high because they were just kind
of put like on this you know, this prescription that
I think that these you know practitioners were just taught
and that's how they were taught to do it. So
(04:59):
in one way, specter like, I'm so happy that they
gave it to you, But in the next one, you
were just like, ah, okay, you know, we're just we're
gonna have to fine tune that and tweak that a
little bit because that doesn't work for everyone, right, I.
Speaker 4 (05:12):
Agree, Yeah, so you get I'm the same. I really
feel like over the last few months, I've been seeing
so many of those particular patients who are on something
and then they go back to follow up and their
clinician has kind of maxed out on what they know,
which is understandable, right, because we don't get any training
(05:33):
in this, and so that clinician has probably thought, oh
my god, this is all missing from my training. I'm
seeing it all over social media. People are talking about it,
my patients are ask me about it. I need to
learn something, And so they do their best, and then
they get to a point where unless you've had a
ton of experience, or unless you've done a particular course,
(05:53):
you're just not going to know what to do next,
you know. And I have had those women come in,
who are you know in their late fifties, haven't had
a period in many, many years, and we're slapped on,
you know, a seventy five microgrant patch and are now
beving or a poor perimenopause. A woman who's in her
(06:14):
early forties and is on this twenty five microgrand patch
and it's not doing anything for her, you know. So, yeah,
that's funny that we all feel like we've been seeing
a lot of that. It must mean that clinicians are trying.
Speaker 1 (06:28):
Right, yeah, right, which is good, which is good, you know,
but you're just like, okay, now, now what do we
do with this? And I think, you know, and let's
maybe let's go back a little bit and talk about,
you know, why does this vary for every woman? You know,
let's kind of take it back and to why at
least we all take an individualized approach, you know, is
(06:48):
it do we take genetics into a fact, like, you know,
do you guys ask your women like, hey, what is
your what was your mom's menopause?
Speaker 2 (06:57):
What about your aunt?
Speaker 1 (06:58):
What about you know, at least at least a question
of it, you know, if they talked about it, do
you find that there's a correlation there at all?
Speaker 2 (07:06):
At least for some symptoms.
Speaker 4 (07:09):
For me, nobody knows. I mean, this is not something
that's ever been spoken about in any family. I think
there's the rare patient that you come across that says, oh,
my mom went into menopause when she was thirty seven,
you know. But other than that, I find most of
my patients don't know what their mom or their aunt
(07:30):
went through. Yeah.
Speaker 5 (07:32):
I think that's a good point. And you know, I,
you know, I counsel women. You know, this isn't your mother's,
sister's daughter's friends menopause. You're not going to have your
menopause experience is not going to be like like someone
else's because I want to remove that expectation that they
feel like, you know, they're not doing it right or
(07:54):
they're worse than someone else. But you know, I haven't
found that that women model their model their mothers at all.
And you know, in the in you know, the cases
that I you know, talk to women, and you know,
and that's some of that might be my own personal
bias because my mom went through menopause at forty one
(08:15):
and I'm sitting here at fifty theory still trying to
figure out if I'm going to puzzle because I don't
think I'm quite there yet. My lab work says I'm
not quite there yet, and so I used to think,
you know, like thirty years ago, I used to think, oh, you're.
Speaker 6 (08:29):
Going to do it just like your mother.
Speaker 5 (08:31):
And now I think, just based on my personal experience,
I I like, I now just have this thought in
my head that you know, and just from talking to
people that it really it doesn't It doesn't really run
in lineage, is what I'm noticing. But I'm also I'm
also fearful of, you know, pointing that out because I
(08:52):
don't want them to think, you know, I just want
them to have their own experience and not be biased
or tainted by other people had.
Speaker 2 (09:02):
Yeah.
Speaker 1 (09:02):
Yeah, I feel like I get more so the point
like both of you where my patients don't really know.
But I do have some that have said, hey, you know,
my mom went through it like forty five, or my
mom had really horrible hot flashes and really terrible mood,
and you know, this started for her about the time
(09:24):
that this is starting for me. And sometimes that helps
them understand. And I had that same discussion with them.
Your menopause in your journey is yours, but sometimes it
helps validate what they're maybe they're going through because you know,
mom did as well, or you know, or if they
had admomal bleeding or fibroys or whatnot. Now, what about
(09:47):
the differences in even just ethnic and racial differences with
menopause experiences.
Speaker 4 (09:54):
Yeah, because there's a study going on across America, the
SWAN Study, the Study of Women's Health cross the Nation
that's been going on since the nineties.
Speaker 6 (10:04):
I think yep, ninety six.
Speaker 4 (10:07):
Yeah, and so those women were perimenopausal I think when
they entered that study. And it's a nice slice through
America when you look at the women who are involved
in it. They are not just white American women, which
so much of any research that we do have on
women in America is based on and so we do
have loads of information from that, and we see that
(10:29):
African American women in general, especially when it comes to
vas of motor symptoms, their start earlier, they're more severe,
and they go for longer, for more years. And we
know how dangerous for its motor symptoms can be for
our brain and our heart.
Speaker 5 (10:49):
And the interesting thing that I was just listening to
a lecture this week is that they're least likely to
seek care because their mothers and their aunts and their grandmothers.
Speaker 6 (11:04):
Didn't talk about it.
Speaker 5 (11:05):
And so I think that is a really interesting point.
And in that particular lecture, they you know, the point
of it was is that as providers, we should be asking,
you know, the premenopause counseling and opening up the door,
because if we don't open up the door for women
to feel comfortable talking about it, they're likely not going
(11:27):
to and then they're going to suffer for much much,
much longer than what's necessary.
Speaker 1 (11:33):
Yeah, and I think it's it is, and it's very
important to you know, to also understand that when you
take care of a diverse population of women that you
it's it's I think it's even more important to open
up that conversation so that way your women know that
they can talk to you, that you don't understand that
(11:54):
there are different racial and ethnic symptoms and experiences that
are had and that we're not going to generalize their
experience either, and we're not going to you know, it's
very it's as much important as our next female patient.
And so you know, like our our our Asian women
(12:18):
and bone pain and and even the Latino population has
has more severe hot flashes and night sweats and those
can last longer as well, or smanitization where it's more
muscle pain and and body pain as well. So it's
just really important for our listeners to understand that, you know,
there there are very much differences in the way menopause
(12:42):
is experienced in women, and that's not a one size
fits all so and that's very important for practitioners to
understand that and to and to address it.
Speaker 6 (12:54):
Yeah, go ahead.
Speaker 4 (12:56):
If oh, I was just gonna say, I was trying
I was thinking mac on that ground from the Swan
study and I think it was I haven't you a
Hispanic women were affected the most when it came to
basic motor systems. Caucasian women were in the middle, and
then American, Chinese and American Japanese women were affected the least,
just when it came to basic motor symptoms. That doesn't
(13:17):
like any other menopausal symptoms. But I just find that
so interesting. You know, we don't know if it's genetic,
dietary and a difference in the quality or the availability
of medical care like it's so righting, probably multifactorial.
Speaker 2 (13:36):
Very much so.
Speaker 5 (13:37):
And the and the thing I thought was really interesting
is that you know, Hispanic women will peak in late
perimenopause with their symptoms and then by menopause they're over.
And then Chinese women their symptoms especially beaso motor or
(13:59):
highest post menopause. And then there was in that same
lecture they were talking about that because of the high
soy intake among Japanese women, that only about fifty percent
of that of women will actually have any basomotor symptoms,
and that there's peak just tiny little bit, but the
(14:19):
lowest of all the ethnicities in the perimenopause, late perimenopause
and then postmenopause they're not having problems. And that then
that's frightening about that is that a lot of women
don't seek care if they're not having beasomotor symptoms. But
you know, Asian women are so much they're smaller, smaller structure,
(14:41):
smaller bone frame to see osteoporosis and osteopenia, and they're
not seeking care because they're not miserable. So I think
that is, you know something, That's why it's just so
important for clinicians to ask and and then to realize
that everyone experiences their symptoms at a different you know,
(15:05):
at different time intervals.
Speaker 1 (15:07):
Yeah, and I find it very important when I'm educating also,
you know, different different women that I take care of
that I let them know that exactly what we just said.
Speaker 2 (15:17):
And you know, whether it is.
Speaker 1 (15:19):
A Latino woman, a black woman and woman of color,
or an Asian woman, I tell them. I give them
all of that information. And almost always they're like, I
never knew. I just thought it was a little bit
of hot flashes, and I'm like, no, those are really
important for you to take care of.
Speaker 3 (15:36):
Those are really you know, they affected your brain and
your heart, and so you know, they really appreciate too
that a your a just discussing menopausem that it is
a one it's not a one size fits all. But
then you're also coming back to like, I see you
as an individual and that you have different risk factors
because of that, and we need to talk about them.
Speaker 6 (15:55):
Right and depending on you know, how they present. You know,
it gives you.
Speaker 5 (15:59):
Like age of you know, where you would start in
terms of hormone therapy, because you know those super flashers
that are have in tons of hot flashes that are
like the media where they're soaking wet in bright red
are going to need a higher dose of menopausal hormone
therapy than someone who says, my hot flashes really aren't
(16:22):
that bothersome You can start them much lower, so you know,
looking at you know, their symptoms and then being aware
of you know, hey, you know they may start out
not bad, and then when I give them a little
hormone therapy, their hot flashes may get worse as they
make that transition through so and being. And I think
(16:45):
one of the things women need to realize is, you know,
it is absolutely normal to be on multiple different doses
throughout there.
Speaker 6 (16:55):
Why we're figuring it out different routes. Try them all.
Your insurance will pay for almost all of them.
Speaker 5 (17:01):
A little tricky on that fem rong, but you know,
try it out and find out what works for you.
And you know, I think people are afraid to say
I don't like it, say I don't like it, because
whatever you pick, you can you know, it's the next
forty years. So let's let's experiment and figure out what
which one works for you. And you know, if you're
(17:23):
still having symptoms, it's okay to go up on the dome.
Speaker 1 (17:27):
Yeah, and our receptors right not everybody's receptors work the
same way, So you could be great at a point
h two five depending on your receptors and how saturated
they get and some don't, or the route and how
your skin absorbs or your gut absorbs, and and so
that is another reason you know this one size fits all,
(17:49):
because everybody's receptors are different, and where your body decides
it wants to take the estrogen progesterone testosterone first, right,
you know, you might want it in your vagina, but
your brain may take it first or vice versa.
Speaker 3 (18:04):
So so true.
Speaker 4 (18:07):
You mentioned the SOI in Asian women's diet, Christine, So
that kind of brings us on to lifestyle factors, doesn't it,
Because that SOI has phyto estrogens in it, so plant estrogens,
and if you eat a lot of plant estrogens, they
can definitely help with Like we do see dietary differences
(18:30):
in women's and what symptoms they have and how, and
we see a difference depending you know, like if you
are having terrible hot flashes and you are able to
lose weight, now it's very difficult to lose weight in perimenopause.
You're having hot flashes, your sleep is obviously disturbed. But
if you are able to lose weight, we do see
(18:51):
that your hot flashes improve, you know, so an exercise
can help as well. So lifestyle, Will we talk a
little bit about lifestyle factors.
Speaker 5 (19:00):
Yes, yeah, you know, we were talking about you know,
wine a few minutes ago, and you know, it's you know,
it's a sad, sad sight, but at least for me,
I live in the middle of wine country. I think
I've said this before. I really don't have a wine problem,
but I do enjoy it. I used to enjoy wine,
(19:21):
and you know, I'm finding now that I metabolize it
much differently a glass of wine. I might as well
have drank the bottle of wine, because it goes to.
Speaker 6 (19:30):
My head, you know, very very rapidly. I don't sleep.
Speaker 5 (19:34):
I have hot flashes all night, and you know, and
you know that definitely, you know, you know is a factor.
And you know, of course the surge in general has
you know, put forth that you know, smoking and alcohol
are just as dangerous and you know for cancer rous
and so alcohol and then highly refined processed foods and
(19:59):
sugar that's also going to be a problem for your
menopausal symptoms as well.
Speaker 6 (20:06):
As your metabolic health.
Speaker 4 (20:08):
Yeah, anything that's inflammatory, right, we tend to really overreact
to things that we used to be able to tolerate
and we're inflammatory, like sugar and alcohol. But I really
think that going through the menopause transition and that lack
of estrogen on has such an effect on our liver.
(20:30):
Like we see what happens to our cholesterol production that
really ramps up, and the liver is integral to so
much metabolism. When it comes to alcohol as well, you
have to wonder is that the link you know, that
our livers are no longer able to metabolize that alcohol properly.
(20:50):
And then I don't know if you guys see this
a lot as well, but I have it and I
see it a lot in patients. Is that mast sell
destabilization that occurs and people will say they get that
flushing a lot certain foods and alcohols, And you know,
I think roseation is probably tied into that a little
bit as well. And all these things that we don't
(21:13):
one hundred percent understand, but obviously our hormones are so
involved and integral in those processes and we start to
get it. Then during the menopause transition and it just
makes everything so much more miserable.
Speaker 1 (21:29):
Mm yep, yes, And I think you know, there comes
that important discussion of you know, good lifestyle habits and
not smoking, and you know, minimal alcohol or no alcohol,
good sleep, you know, all of those things that we
really should be doing, you know, in our twenties and thirties,
(21:50):
and which would you know, it'll be interesting as maybe
that shift changes, to see how this perimenopause and menopause
transition will shift.
Speaker 2 (22:00):
Will it shift?
Speaker 1 (22:01):
Will they have a better perimenopause and menopause if those
lifestyle changes are are it's something that they are taking
on earlier in life, It'll be It'll be interesting.
Speaker 2 (22:11):
You know, we.
Speaker 4 (22:13):
Need the research we do because we see it ourselves
and we see it in our patients. Right that once
we are able to start working out, if we're able
to make changes and get some sleep, Yeah, things do
turn around, don't they. Like our lifestyle factors are so important,
not just the hormones. But I feel like a lot
of us go around so exhausted and kind of in
(22:35):
this inflammatory state that even our adrenal glands, which produce
testosterone on a daily basis, probably aren't functioning that well.
You know, and when you are getting your sleep and
you're feeling better and you're in a less inflamed state,
you're pumping out more testosterone which can get converted to
estradile and so just overall feel better and healthier evenly.
Speaker 1 (22:58):
Right, And that test goes up, and then you know,
maybe some other things are wanting to happen a little
bit more.
Speaker 2 (23:04):
Often too, because you're getting your sleep and you're you're getting.
Speaker 4 (23:09):
Yeah yeah, have energy, yeah.
Speaker 1 (23:12):
Yes, yeah, you want to be intimate with your partner,
you know, or yourself or whoever, and so it all
that all plays a part in that, you know, and
I think that so you know, lifestyle factors, but under
health underlying health conditions too, right, So making sure that
you're managing your thyroid disorders and and your diabetes or
(23:36):
your impair fast and glucose, or you know, other autoimmune
diseases like rhumatured arthritis and things like that, because those
can all flare and get wonky too as you're going
through that transition. And so it's important that a. I
think that either your indocrinologist or your rheumatologist or your
you know, primary care provider is also understanding that maybe
(23:57):
there'll be some changes as you're going through through this
menopause transition, so that they also need to understand that
and make sure that you know, you may see some
some changes where you'll need to tweak some medications or
or that maybe you know you're fast and glucose is
going to be getting a little bit worse when it
(24:17):
was under control and now it's not in control.
Speaker 5 (24:20):
So yeah, And I think the other thing too is
women with the history of pcos or infertility, if they
have spent a lot of time in their earlier years
skipping cycles. I think, you know, that's one thing for
them to realize, you know, is that if you went
a lot of years without ovulating, then you didn't you know,
(24:44):
you still have a lot of follicles, and so you
may go through menopause much later. You may be that
five percent that goes through menopause after age fifty five.
And then for those women, you know, you know our
infertility and our pcostions, those are those are classically associated
with low progesterone, and so a little bit of progesterone
(25:07):
often will help women early in the perimenopausal period, and
that's all they need is to replace that progesterone. But
I think you know people, you know women, you know
you never know when you're going to go through menopause,
but you breastpect for a long time, you had lots
of pregnancies. You may wait and go a little bit
later than other people who've been marching right along have
(25:29):
a monthly menstrual cycles and ovulations.
Speaker 1 (25:32):
Yeah, yeah, what about the problem with a one size
fits all approach. Let's kind of move on to that, Like,
you know, some outdated medical guidelines maybe with some doctors
are still saying to patients.
Speaker 2 (25:43):
Let's talk. I know, we could have a whole thing on.
Speaker 1 (25:46):
That, some misinformation at myths, maybe some of our favorite
ones there, and you know how maybe how menipause symptoms
are still being overlooked. So maybe let's start with some
some things that some of some docs are still saying
to our patients. You know, what are your a couple
of your favorite things about the outdated medical bindlines for practitioners.
Speaker 4 (26:10):
Oh my gosh, most there's a couple that drive me bonkers.
One is you're still having periods, so you cannot be
you cannot take hormones, which makes no sense because we
all know the most symptomatic period is when you're perimenopausal.
(26:31):
Once your postmenopausal, your symptoms will often taper off over
a few years. So when you really need that help
to carry on a normal life and keep your job
and your relationship and your marbles is when you're perimenopausal often.
And then yeah, so that's a big one. So you
(26:52):
have to be menopausal to have hormones right waited out.
Speaker 1 (26:56):
Sorry, this is just part of life.
Speaker 5 (27:00):
And you know, in that same you know, in that
same breath, I have been hearing an uptick of providers
telling patients, well, you're still having a period, so you
can't you can't have any hormone deficiency.
Speaker 6 (27:13):
Everything's normal, it all looks, it all looks.
Speaker 2 (27:18):
Normal to me, It all looks you know.
Speaker 1 (27:20):
And I have to tell you I had a you know,
one of both to that point. I had a patient
that had such horrible GSM and vaginal dryness that that
going to the bathroom was painful to use. Tis shoot
and her whether it was a g one and it
doesn't really matter who it was. Told her, I'm sorry,
(27:43):
you're still having periods. I can't help you, not even
vaginal estrogen. And I'm just like, you know, how when
you feel like sandpaper and you can't even you know,
clean yourself up after you go to the bathroom because
it's so dry and tender and friable. I'm just some
like how it baffles my mind how anyone can say.
Speaker 4 (28:10):
Hard to try and find out where this comes from? Right,
It's like if you were to ask that clinician one
more question, just where did what are you basing for?
Speaker 2 (28:22):
Which book? Where did you learn? That?
Speaker 4 (28:25):
They won't be able to tell you, because it's literally
this myth that floats around. But the only thing I
can trace it back to is the Straw Guidelines, which
I think we mentioned in a previous episode, which were
developed for research purposes to categorize women into whether they
were menopausal or not menopausal or not. Yeah, and it
(28:46):
kind of categorized the different stages of perimenopause, the menopause
transition overall, and you know, it quite clearly says the
first stage is where your periods get a little array,
and then the second stage is where they get more irregular.
And I honestly think that's where all this comes from.
Because people think this is some type of like scripture
(29:13):
that is not how women work. That's not how any
of my patients work. I don't know who they were
basing it on, honestly, but I mean, I have so
many patients who are riddled with every single symptom. I
say to them, I don't know how many of these
are due to perimenopause, but we can start you on
hormones and see they come back so much better. So
I have my answer. And yet they will tell me
(29:35):
their periods haven't changed at all. So this is really
a myth that we need to get past and is
a barrier to care for patients.
Speaker 2 (29:44):
It's huge. It's a huge barrier to care this.
Speaker 1 (29:48):
Misconception that menopause is natural and to just deal with it.
And how many times have we said, well, losing our
eyesight is too, you know, and we wear glasses and
we get readers, and there's.
Speaker 2 (30:00):
So many things that happened. Erect dysfunction is normal. You're right,
you are right.
Speaker 4 (30:08):
Your uterus falling down through your vagina is normal. But
we fix these things. We help them, We don't let
them suffer.
Speaker 2 (30:16):
That's a good point. It's good point.
Speaker 1 (30:20):
Yes, I'm not like, you know, We're not going to
be dragging our uses on the floor, you know.
Speaker 5 (30:25):
So I didn't have I picked that up, and I
did have a lady I did see.
Speaker 6 (30:31):
A ninety four year old came into my office.
Speaker 5 (30:33):
This is when I was in private practice, and she
kept telling me that something fell out and I was like, hmm,
I'm like really falling out. And she sat down on
the exam table and kid you not, the entire uterus.
I saw her inside out cervix. I was like, oh,
bless your little heart, it really is falling out. And
so we pestered herd nothing back in and got her
(30:56):
some help. But poor little thing.
Speaker 1 (30:58):
I did thapse a little old woman because all that
stuff is yours.
Speaker 2 (31:05):
You know.
Speaker 6 (31:06):
That was completely natural.
Speaker 4 (31:08):
That's right, that's not weak and us.
Speaker 2 (31:14):
It's just part.
Speaker 1 (31:15):
It's just part of aging, right, Like that pelvic floor
just gets.
Speaker 6 (31:22):
The lady was carrying her uterus in her underwear.
Speaker 5 (31:25):
Oh my god, it was like a ten centimeter uterus.
Speaker 2 (31:31):
That thing is that. That was ninety four. She had
a big one.
Speaker 5 (31:36):
But you know, I think one of the things that
you know for patients to know that their symptoms are
probably being overlooked is when you start doing the ologist march,
meaning that you're going to the rheumatologists for your joint pain.
You're going to the orthopedist for your you know, for
your frozen shoulder, the e n T for the ringing
(31:57):
of the ears. And so.
Speaker 6 (32:00):
Yesterday I was with a group.
Speaker 5 (32:02):
Of women and that you know that they were reporting
that they were being sent to all of these specialists
and they were they were giving pain medications and antidepressants
and you know, basically by their primary who just haven't
been trained. You know, we're just treating each symptom one
at a time and then sending it all out for
referrals because there just isn't enough education to understand. And
(32:26):
you can't blame providers because I was one of those providers,
Like I couldn't figure out why the anxiety and the
plantar fasciitis and you know, the joint pain and the
harp palpitations were how they could possibly be you know
related if you're not taught perimenopause and if you're not
taught menopause. But for patients, that's your ding ding ding
(32:49):
that it's that you know, stop, find yourself someone who
can look at your hormones and you know, then decide
if you need to move forward with the rest of
your thousand referrals.
Speaker 2 (33:05):
Yep, yep, absolutely.
Speaker 1 (33:09):
Okay, So let's talk about some personalized approaches and what
actually works.
Speaker 2 (33:12):
So hart and non hormonal options, we've talked about that.
I think, well, there's dinosaurs on the back.
Speaker 6 (33:20):
Hold on, I know, I was.
Speaker 2 (33:23):
All right, you girls take over, let me go turn
off my dinos.
Speaker 4 (33:26):
Okay, So personalized approaches, what actually works? So yeah, I
think we've kind of talked through some of these. You know,
our options for treatment are either hormonal or non hormonal.
Diet as in, you know, there are certain things that
we need to change in our diet as we go
(33:49):
through this menopause transition. We just can't keep eating like
we did in our twenties and thirties because our bodies
responding to these foods differently, like these ultraprocessed foods, a
high added sugar, foods, alcohol, yep, things are making putting
us into this really inflamed state, and it's causing and
(34:12):
our joints working. Yeah.
Speaker 6 (34:15):
Absolutely, And.
Speaker 5 (34:19):
I think it's important on the treatment that you have
a that you seek a provider who offers you all
the options because you need you you are in charge
of this journey and you need choices, and you deserve choices.
So if you have someone who says you can only
be on X, then that poses a question or all
(34:43):
the other things contra indicated or is this the only
thing that you prescribe? And so, you know, I think
women really need to have a plan, and you know,
but providers need to present all of the options and
let the patient decide. It's you know, we don't need
to be the one that decides because in the end,
the only thing that matters is one, is there any
(35:04):
absolute contraindications?
Speaker 6 (35:06):
In two? Is it something that's.
Speaker 5 (35:07):
Going to work with their lifestyle that they can actually
manage and they'll they'll do and they feel good about
doing those things.
Speaker 1 (35:17):
No, absolutely, And I think you know, the last few
things is that there are also other things that women
can do to help ease some of their symptoms, and
especially if they're not ready to do hormones or they can't.
I want to be clear that you know, when you're
losing estrogen, you got to replace it, but you can
(35:39):
choose not to replace it, right so, and not just estrogen,
but estrogen progesterone to stosterone.
Speaker 2 (35:46):
However, there are still there are a lot of options
that women do choose.
Speaker 1 (35:49):
And I was talking with a colleague who actually does
acupuncture and had said that, you know, she was treating
someone who couldn't do hormones and it really did get
rid of their hot flashes and it was really helpful.
So you know, when we think about certain supplements or
mindfulness and CBT and you know, therapy and things like that,
(36:10):
that there are there are other options out there while
you're trying to figure this out, or if you're just
not sure or you know you can't, or if you
just choose not to. Because we do have women that
just choose not to, and that's okay too, as long
as you know they have all the education that they need.
(36:30):
That there are also other you know, I guess alternatives
as well to help mitigate some of these symptoms.
Speaker 5 (36:38):
Absolutely, and you know, I you know the great thing
about being telemedicine right when you say what supplements you're
you're on and the patients say hold on a minute.
And it always makes me nervous when the supplements come
over in rubber made containers or we all travel to
(36:59):
the cabinet and there's they just keep coming out and
I'm like, and a lot of them, I'm like I've
never even heard of, because I think a lot of
people hear things on social media and they you know,
try this, try that, And so you know, women are
taking a lot of supplements and they may or may
(37:19):
not be useful for them, and they're spending hundreds and
hundreds of dollars and I think, you know, my best
advice is get your new you know, get your ferretin,
your B twelve, your vitamin D. You're foll late, get
them checked. Are you know do you have a deficiency?
Because if you don't, don't supplement it. Use food because
(37:41):
you don't know what all the interactions are of all
of the medications. And I mean, there's no point in
taking it if it actually isn't solving a problem that
you have, So be adding problems for all you know.
Speaker 1 (37:54):
That's that's right, that's right, and replacing your home runs
is they're now medications. When we talk about being natural, right,
we have natural options and so we want to fix
those things that aren't you know that you are having
(38:14):
that are declining, and if that's what you choose to.
Speaker 2 (38:18):
Do, but I don't.
Speaker 1 (38:19):
I always just tell my women, you know, I'm gonna
give you all these options I don't want you to
be afraid that it's not natural.
Speaker 6 (38:26):
Yeah, like erect right, so exactly, all right?
Speaker 2 (38:31):
Any other key takeaways?
Speaker 4 (38:33):
Yeah, I have some takeaways ready for us. So I
would say Number one, educate yourself. We always we've mentioned
a few times some good books. You know, Estrogen Matters
is always a great one, and it really goes in
depth into all the hormones and the safety of them,
so it takes away that fear. And if you read
(38:53):
that book, you're probably going to know more than ninety
percent of clinicians in this country about your hormones. Number two,
talk to your own clinician and see where they lie
with their knowledge of hormones and whether or not they
could get you started on them, because even to get
started will answer a lot of your questions, and then
(39:15):
you know, maybe they're going to learn with you, maybe
they're open to that. Some are. But if you get
to the point where you feel like you've plateaued and
you are just not on the right dose for you,
but you know so far things have really improved and
you know you just need to go a little bit further,
then if your clinician's not going to work with you,
(39:36):
I think the only thing to do really is to
go looking for more help then, you know, and I
suppose the list that we use. We always direct people
to the Menopause Society where you can find clinicians who
are certified. Doctor Mary Claire Hafer has a list of clinicians.
Speaker 1 (40:00):
Other listen my two main ones, I would say, yeah, yeah,
and again call call, call them if you can make
a call for when you do find one, and ask
how they work and how they prescribe and if they prescribe,
and what our thought processes. That can save you a
little bit of time and money as well, because not
(40:20):
everyone practices the same even though they're certified.
Speaker 2 (40:26):
So that's it. That's a big thing. Hopefully that will
change over time.
Speaker 4 (40:29):
But yeah, I agree, And we share some wonderful information
on our social on our accounts and social media crents.
So if you're employing these podcasts, please subscribe and lead
review and follow us on social media. And our next
episode is coming up soon and it's going to be
all about the most common questions women ask at the
(40:50):
M Factor screamings, So we'll see that all right, Bye everyone, Hi, everybody,
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