Menopause Happens - A Real Talk with Dr. Maureen Whelihan

The Red Lips Real Talk podcast, hosts Jasmine, Jessica, Monica, Mariza, and Deibys, dive deep into menopause and midlife, focusing on what Gen X women need to know. Special guest Dr. Maureen Whelihan, a board-certified gynecologist and menopause specialist, discusses the physical and emotional challenges women face during perimenopause and menopause. The conversation covers symptoms like brain fog, mood swings, sleep disturbances, and the stigma around discussing menopause. Dr. Whelihan offers insights into hormone therapy, particularly the benefits and considerations around estrogen and testosterone treatments. The episode emphasizes the importance of being your own health advocate and seeking evidence-based treatments.

Dr. Maureen Whelihan ~ Elite GYN of the Palm Beaches  

561-965-9559  

https://mygynpractice.com/

Linkedin 

Fortune Article - Many Gen Xers demand menopause hormone drugs, and they won’t take no for an answer

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Transcript

Hey Chicas. Welcome to Red Lips Real Talk podcast. I'm Jasmine. I'm Jessica. I'm Monica. I'm Mariza. And I'm Deibys with a wife. Get ready, Somos Latinas from South Florida bringing you real talk on life love and everything in between. Time to get real Dale. Hello, listeners. Welcome to Red Lips. 

Hello everyone. Hi, welcome. Good evening. Thank you for joining us in our next episode. Before I introduce our amazing guest that we have here today, we're gonna dive deep in our really important topic that is affecting all of us, especially everybody here. On the table, we're gonna discuss menopause and midlife and what Gen X women need to know. 

Mm-hmm. Did you know that more than 65 million Americans are part of Generation X? US scrappy, independent, latchkey kids who grew up fending for ourselves in the eighties. Now as more than half of them are women, we are navigating a new chapter. Perry, menopause and Menopause. We're in this boat together, ladies. 

Oh yeah. Oh yeah, we are. And sometimes it's sinking. Yes. Feels like that sometimes. Definitely. Unlike previous generations, gen X women aren't just accepting the changes in their bodies without question. They're searching for answers. We are demanding better healthcare, and we are refusing to suffer in silence. 

So we're turning into bloggers, social media, podcasters, such as red lips, because let's be real, we weren't given much of a roadmap from our mother's or even our healthcare system. That's where today's guest comes in. Dr. Maureen Whelihan, a board certified gynecologist and menopause specialist, and she's amazing, is seeing this shipped firsthand in her Florida clinic where she says, gen X women are showing up before menopause even begins. 

Looking for solutions. She's here to break it all down. What's happening in our bodies, what we can do about it, and why we don't have to suffer in silence. So grab your coffee, your wine, whatever gets you through the day because we're diving into menopause, the Gen X way. 

Alright, so thank you for coming, Dr. Whelihan. Welcome. Welcome. We are so excited. Yes. Thank you for coming. Absolutely. Awesome. So before we get into the nitty gritty, tell us a little bit about yourself. Well, I. So I started off like most ob GYNs, uh, delivering babies, having all the fun. Uh, but at some point I decided I wasn't gonna do that anymore. 

And when that stopped, when the OB stopped, my practice changed. All of a sudden, the women that were coming in to see me were 40 and over and had a whole new set of complaints, low libido, uh, hot flashes, irritability, PMS. And so while I was interested in these topics, I felt like I really needed to know more. 

And so I joined an organization that really focused on women's sexual health, the International Society for the Study of Women's Sexual Health, who knew that there were all these people specializing in this. And with that, not only did I have the interest in helping the women, but I then learned what was available and what was going on to create these problems. 

And so with that, I of course learned about, uh, all the hormonal adjustments and things that happened in regards to libido and sexual health. But just across the decades how women have to evolve. With their health and what the benefits of the hormones are and um, how we can just feel better. And someone has to listen. 

If there's anything I've learned throughout this time is that women want to be heard and they, the most common thing I hear is they feel very dismissed by their physician. It's all in your head. Hey, welcome to the club. We're all like this. Absolutely not. And so with that, uh, I've noticed that about a third of the women coming into the practice now are in their forties. 

They wanna hit the ground running before they even lose that last functioning ovary. Uh, and so, uh, get ready ladies, 'cause we're going to share some facts and make everybody feel better. Oh, I wait. No, I can't wait. I can't wait. I cannot wait. We need answers. We need answers. Well, going back, um, since with the introduction, I, I, I quoted certain specifics in the article that I happen to come across, which I thought was amazing article that you're mentioned in, along with Doc, another doctor, Dr. 

Claire Haver. And I remember the first time for the audience that I know Dr. Han is my doctor. And, uh, you changed my life. You really have. You've really changed my life. You saved my marriage. Thank goodness. Thank you for saving me. And so. The article I felt like really represented my journey. It stated that I, I found information through social media. 

Mm-hmm. I mean, I was, uh, really quick, uh, a year and a half ago at my wit's end that I was going crazy. Um, really in, in that particular, uh, praise, uh, is a lot of what my friend's description utilizes like, they feel like they're going crazy. And, um, I had really weird symptoms at the time. I had like frozen shoulder, uh, I had itchy skin. 

I had itchy ears. I had. Um, rheumatoid arthritis in my hands, which I self-diagnose for like years, not unknowing, that it was part of also perimenopause. I had joint pain in my hip, so I suffered with a lot of pain and I wouldn't say anything to anyone 'cause I thought, oh, this is how it is being in your forties. 

This is just part of being forties. Then I started losing my hair. Then I started getting, I was bloating. I had. Uh, my gums were bleeding. I had the weirdest symptoms, and then, then we went into a whole other level. It was cognitive changes. I was having panic attacks, anxiety. I was, um, I had issues with word finding. 

I would walk into a room and not know, uh, why I was in there. I had, um, irritability, mood swings, and it just felt like I was going downhill. And I remember just, I was at my wit's end and I was not able to make simple decisions like. Jessica, what do you want for your cabinets? What colors do you wanna choose? 

And before I used to be like, Hey, on my toes, like I was able to like, Hey, look, I could figure this out. And I found myself just, I thought I was getting the beginnings of Alzheimer's. And then I, I was just like, I need answers. This cannot be that. This is where I'm at in my life. I am a, I have toddlers. And so when I went to, um, I started looking for answers to social media 'cause I was like, I cannot be alone. 

Then I came across Dr. Claire Haber and I went into her website and she, thankfully I found a clip where she was mentioning how you can find a provider near you that specialize in menopause and it was in the Menopause Society. I found you. And I was like, holy hell, I gotta make an appointment. And I came into your office and. 

We started talking and you listened to me. Mm-hmm. And I felt for the first time, so relieved, not alone and comforted to be honest and relieved that I wasn't going crazy. And um, so with that. Said, I think it's important to really start at the basics. Like what is perimenopause and what's the difference and what are the, the hormone changes that we're, we're going through. 

So the ovaries start, uh, functioning when we go start our periods and they stop functioning for most people around age 51. But it's genetic. So, uh, so some people will go through at 48, but there's a period of time in the five to eight years before the last period where all hell's breaking loose. Let's face it, your hormones are up. 

One day down the next day, one month, you feel like you can run 10 miles the next month. You feel like you're dragging cinder blocks behind your butt. Yeah. And so, uh, and I remember all of this myself having gone through that, but what's happening is that the ovaries are not as predictable and reliable. 

So that perfect 28 day cycle is no longer, uh, sometimes it's 25 days, sometimes it's 30 days. And so with this, your hormone levels are fluctuating. They already do anyway, so we already feel neurotic most of our lives. Mm-hmm. Because we have two weeks of. Feeling fabulous with estrogen, and then two weeks of being bloated and bitchy with progesterone. 

And so we're already on this seesaw. Now you're gonna shake it up a little bit and make some, um, levels of hormones that are just not stable. And so that's where all the aggravation begins. For some women, it's clarity of thinking, focus, how many times a day I hear foggy brain. Mm-hmm. Uh, difficulty in my ability to focus. 

Sometimes it's hot sweats and night sweats, and, uh, my ears are, are uncomfortable. I, my feet are hot. Everybody's, uh, description of what it does to them is a little different. Mm-hmm. And so understanding that it shows up in each individual in a different way. Uh, for some people it's, uh, weight challenges because they're eating like a lunatic. 

Because they feel up. They feel down. They're hungry. They're not hungry, and they're packing on pounds, and they're really just another level of aggravation because then women start focusing on that. So these hormone changes are up and down. So the goal when we're trying to manage this is. I just wanna keep you off the lows. 

Your highs are still pretty high, and you're not complaining to me. When you're there, your lows are where you are acting differently. Who do we take it out on? Our family, of course. No wonder divorces happen in people in their forties. Oh yeah. For goodness sake. The, the wife becomes the who is the woman in our house. 

The kids say, I want the nice mommy back. I feel like every month, every other month, it's a different person that gets him more than the other. Sometimes the dog's aggravating me more than my husband Sometimes you're like, whose turn is it? Uh, and so. All of these changes are happening and we really do take it out on our family, but we then take it out on ourselves because there's so much guilt involved. 

Oh gosh, involved, yes. Involved in our bad behavior. And especially when it's the pmms or the irritable, you know, crazy behavior. So now it's self-reflection on how we've behaved today. And we are embarrassed that what we did in the boardroom at work or, or so forth. So, uh, I'm so. Celebratory when the husbands managed to stay along. 

Uh, I, I try and focus on sexual health sort of early. So like throw him the bait. At least if we can him in, get him hooked in with the sex, uh, he'll tolerate any bad behavior. Yes, very true. There is a limit for that. But, uh, for the most part, so our poor family, the good news is if your marriage makes it through this difficult time, it's usually very strong. 

Nice. So that's a good sign. But managing and navigating these waters and trying to pick off, I always start the conversation when, what's the most bothersome symptom for you? Right. And, you know, sometimes I hear something like nausea, I'm like, okay, that's not directly menopausal, but let's see what you're really trying to tell me. 

And then we get into, so another story, and I'm like, oh, okay. Oh, I can see the nausea link here. So listening is really how, really part, how can someone determine if they have perimenopause? Everyone goes into the perimenopausal period, which is the five to eight years before menopause. Now you don't know when your periods are gonna stop unless you have an older sister. 

Your older sister is. If you share the same parents, then it should be about the same, assuming that neither of you smoke, smokers go through younger than non-smokers, but sisters generally all go through the same. So when I see somebody at 51 and she's still having a period every month and hasn't skipped, well, you're not gonna be the national average, which is 51. 

How old was your sister? Oh, she stopped at 54. Well, there you go. It's gonna be 54. Don't rely on your mother. They seem to not remember that perimenopause was a thing. Yep. It was a non-issue. I don't know. I remember my mother, remember there was something going on. Mm-hmm. I didn't know what it was called, but it wasn't good. 

Yeah. Uh, so, so everybody goes through perimenopause. So what is hormone replacement therapy and how does that work? And, and I don't know that replacement is what we use anymore. Okay. But hormone therapy, okay. So hormone therapy is simply saying, how can we manipulate the regular hormones? So for girls, estrogen is our mean hormone. 

Uh, testosterone is another hormone we have and progesterone. And so how do we manipulate those to make you feel the best? So you have to know what they can do. You know, what is the end game for each of these hormones? What can I actually improve? And then we use those. And so do you, do, do you have to do a blood test? 

Because I, I found it like I, at least for me particularly, I, um, I came into your office and I knew what I needed. I was like, you're putting me on. I was like, please put me on HRT. Yeah. But for those, for like, how do you know if that's a good fit for you? Like how do you, how does that work? So levels are really not helpful. 

Okay. For a couple reasons. One, they're changing constantly in a given cycle. They change twice in a day. Our hormones are a little different in the morning, higher in the morning, between four and 8:00 AM a little lower in the afternoon, um, throughout the month. Estrogen predominates from the first day of your period till ovulation, and then progesterone tends to be the, uh, one in charge. 

Uh, testosterone is relatively stable throughout the cycle, and so measuring a level isn't helpful to me because you are not a number. You may need more estrogen and you may need more testosterone. So when people want a number, I'm always like, well, what number are you shooting for? Because I'm really shooting for a good end result, and in my mind, I know what products I'm using and how much I'm delivering to you. 

So I have a sense on what level I'm giving you, but if you are not feeling good at the level, I think you should be feeling good. I'm going to give you a little more. When I start to move into, uh, ranges that seem not normal. Mm-hmm. Then I'm going to do a level to make sure you're absorbing what I'm giving you. 

So that's when levels become apparent and helpful. When people are compounding products, that means an individual is making a special potion. It's usually done in a cream. Creams aren't absorbed through your skin as well. Your skin is a barrier. It's intentionally made to protect you. So things will go through better if they're alcohol based as a closed to just a cream. 

So sometimes levels are used to. Get the patient back to the office. You'll notice in a lot of these boutique clinics, come on in, let's check your levels three months later, come on, we'll check your levels again. They know you're coming in to find, am I, am I the right number? And are you gonna feel happier because the number she said was good, or you were on that way? 

Still feeling bad when you're on your way to that clinic visit, right? So just because your number is great. Are you better? No. So we wanna know how you feel and if you use FDA approved products, you know how much you're delivering, so you're within a safe number. So speaking of FDA, what are your thoughts on testosterone? 

So there are no FDA approved products for testosterone, but there are several trials, long term, five year safety and efficacy trials saying that it is both effective for women, especially for libido. That's what it's been studied for, and it's also safe. No increased breast cancer risk, no increased cardiovascular risk, all the things that you might be concerned about. 

So these have been played out in two really nice long studies, both five years. Uh, Susan Davis was the leader lead author in these, and so we have data, but when the companies tried to bring something to the FDA for approval, the FDA just wasn't open to testosterone in women. So for the last 20 years. 

We've been prescribing it off-label. So I use an FDA approved product for men because we know that women need about 10% to 20% of a man's dose. So, uh, that is our goal when we're looking on, uh, where do we wanna treat women? So we use 10 to 20% of a man's product. So if you know what the menus and the dose you're giving to a man, which is well studied. 

Then we know where to start for women, and then we sort of take it from there. Well, I can speak about that firsthand because I got testosterone. Yay. It was the darkest time of my life. I feel like I'm listening to everything that you're saying, and I'm, I feel vindicated. I feel like, wow. Like I'm actually listening to someone who's making me feel like all the things I was going through, when I would go to my gynecologist, I was with him for 10 years. 

I, I stay. I'm loyal. I'm loyal, you know? But all the time it was like, well, that's the way it is. You know, it's a part of aging. And I accepted that answer and I confided in a friend and she was like, oh, no, no, no, no, no, no. And I, I really appreciate so much that that conversation, I feel like it was, uh, meant to be. 

And I ended up getting testosterone. My level was non-existent. It was, uh, about seven. Mm-hmm. I believe. Mm-hmm. Um, it was so bad, uh, Dr. Willa hand that, um, when you mentioned. You know, difficult times in your marriage, and then if you're able to get over that, how you're gonna be in a good place. That's exactly where I am now. 

I, I feel like I'm in the best place in my marriage, but at that time, I was an a completely different woman. And if it wasn't because he was the one that was putting in the weight to say, no, I'm, I'm fighting for us, I, I probably would've left. I was in a, in a dark place. I, I don't even know who that woman was. 

So by the time I went to, to see a licensed practitioner nurse, okay, okay. Uh, they put a pellet. Okay, a pate. And she said, it's gonna take a little while, maybe a couple days. And I, I'm gonna tell you, within a matter of seven days, I just was like, let's go for a walk. Let's go out. I was happy. I wanted to make love, you know, I, I just felt so pretty, you know, I felt wonderful. 

Were there side effects? Yeah. I got a little hairy, nothing, a little waxy can't fix, you know? Exactly. Oh, I gained about four pounds. But I didn't care. I didn't care because I just felt so wonderful. And that's why I be, I've become personally a little bit of an advocate with my friends and family who are going through this. 

And, and sometimes there's a little bit of shame talking about this, especially in the Latino culture. 'cause we didn't grow up talking about this. Right, right, right. Um, and then when, now, like you, Jesse said about the Gen X community, how we are not taking no for an answer. And I love what's happening, that we're able to find solutions to making ourselves, uh, feel better and don't take no for an answer. 

So pellet therapy sort of was introduced. It's a compounded, uh, waxy bullet, if you will, that's implanted under the skin. So the intent is that it can last longer with that, in order to get something that lasts three to six months, you have to raise that level pretty high because you've got a. Counteract it's gonna come down over time. 

So we consider pellet therapy as high dose therapy. So it, it was a high dose. Yeah. So because I had my numbers checked, the numbers can go up to 800 sometimes. Well, no, no, no, no, no, no. God forbid it'd be like Hercules. Um, no, it was up to a hundred. I got, oh, that's not bad actually. That's the numbers we're shooting for. 

Yeah. So that is not high dose therapy. Oh, okay. So when we're, when you look at the studies from Susan Davis on, uh, libido, uh, the target range is 50 to 150 on the testosterone levels. So that's nanograms per deciliter. You guys don't need to know that. Um, with pellet therapy, we usually see numbers 200 to 800. 

You figure that's about a man's level. Now an 80-year-old man is 200. Some of our husbands might be 200 as well, uh, if they're low T. But if you get above two 50, sometimes women will feel a little bit pressured or irritable. So some women may experience it as too much, certainly acne, hair growth. But you're right. 

If you're feeling strong and vigorous and a little, you know, interested, more interested, sexy sex, little time. Yeah. You get a lot of wicked sexy thoughts in your brain and they're, that's really fun because you're like thinking what you're thinking and going, oh my gosh, I hope nobody knows what I'm thinking that now. 

Well, I like how you posed it. I remember when, when we talked about, 'cause I, I, I do the gel testosterone. Mm-hmm. Mm-hmm. Which has been great. Mm-hmm. And I remember, uh, I liked the way you posed it. Um, if, I dunno if you remember, you probably use it on your pages and you say, you told me, you were like, well, do you want to go hunting or do you, I forgot else what else you said. 

You said, yeah. Do you wanna go hunt? And I was like, that's a great way to put it. Right. Because I was like, I think I'm good where I am. Yeah. You can certainly have multiple layers of being vigorous. Uh, so gel therapy gives you the ability to go as slow and low as you want. A pellet is put in you, so you got it. 

May, may I ask you a question about the pellet? Yeah. Because I've only had it put once, so I feel like now I'm ready to go. You for the next one. It's been three months. I, I actually can feel, well, no, it's been longer than three months. I think it's, yeah. Considerably longer. I've been, it's been about six months. 

Yeah. Also, now I'm starting to feel like, oh, I'm starting to feel sluggish again. Right. But I, I do have to be honest, um, it was very sensitive and sore in the buttocks area where the implanted it. Mm-hmm. And then about maybe four weeks ago, it started to like sting a little bit. Like, just like a little sting. 

It did. It wasn't a huge pain. But I was wondering is that it like completely wearing off and you can feel it or am I crazy? Um, you're probably just feeling where the di that the pellet was put under your skin. So that would be a local skin reaction. Oh, okay. Unrelated to your skin is not really sent telling you that it's dissolving the way you feel is that sluggish feeling? 

Yeah. It's back the slump. Yeah. A lot of people say so. Um, your is coming it, so do recommend because it worked so well for me. Yeah. That I should continue with the pellet or maybe try another alternative. I think you have success. So I would do what you're doing. Especially if you're getting six months out of it. 

That's a value. Yeah. Because when they look on price and your numbers aren't that high. Yeah. No. Well, I went to check 'em. Um. Two months after they had put it. So is that the last time you checked it? Yeah, but I, I've been feeling great up until about two, three weeks ago, time for another pellet. I'm just starting to feel like, oh, get that pellet in. 

You know, it's funny, my husband was like, is it time to get the pellet? Thank goodness they know before we know. Yeah, you're getting a little crankier. She's not chasing me around the house. She's not hunting. That's right. She's not standing in front of me naked. Oh gosh. How do you know? So I wanted to, uh, go back to, um, uh, Jasmine had mentioned, you know, being in a dark place, um, with perimenopause, and I wanna add this, this, this is to me was, uh, crazy. 

So suicide rates among women aged 45 to 54 have risen by 60% over the past decade because of being in this journey. And that's scary because I know. I, I was in that dark place, um, many women. Mm-hmm. And, and it's scary too because even I, I, I notice friends of mine that have, are going through their own journey and I can foresee like that isolation and that reclusiveness happen. 

Like I, to me, that's what happened to me. 'cause I felt like, so, um. I was malfunctioning. Mm-hmm. And it was, as you had mentioned, Dr. Wiley, like you took their words right outta mouth. My mouth is exactly what I was feeling was like, there's a shame behind it. And it's like, you don't want people to see you like that 'cause you're trying to figure out what the hell is wrong with me And I, I can't function in society. 

So with mental health, how does perimenopause impact mental health? You know, that's a great question. Uh, that's a pretty alarming statistic, unfortunately. Um, but it's very interesting. Even women who have never really had a problem with anxiety before will come in. Now they'll say, I'm having these, these big thumps in my heart that go up into my neck. 

So of course that induces panic because you're sure you're having a heart attack or something because you feel like crap. That's what it feels like. Yeah. Right. Yeah. Um, but new onset anxiety is really common. And, and is these palpitations. And a lot of times when women, you know, are telling me about this, sometimes it's hard to tease out is this a mood disorder that's not been treated and this is not new. 

Or, you know, if I'm, especially if I'm meeting somebody for the first time. So I always go back and say, well, how did you do after the birth of your child? And some will say, ah, you know, I needed Zoloft for, you know, the first year or for six months. So postpartum this, these swings in the, in the hormones are very similar to postpartum. 

You had the big crash of hormones and the placenta comes out and the estrogen and the progesterone crash. Your sleep deprived, your, you've got a newborn, it's a mess. Your hair is being lost, your 50% of your hair volume is gone. It's very similar. Um, and so. If they had a mood disorder during the, the OB period after the baby, then there it might need something more than just hormones at menopause. 

But for the girls who's never really experienced, uh, significant anxiety, um, estrogen may do the trick. And I think that a lot of OBGYNs, other than those who know about hormones, the ones who are dismissive. Aren't looking beyond the hot flash. We all know it helps with hot flashes, but that's not always the primary symptom that's affecting my patient. 

And so thinking beyond the other good things that it does, the joint pain and the foggy brain and the concentration and the sleep, um, you start to really understand, you've gotta listen to the patient and you're not gonna hurt anybody by giving them a little bit of estrogen. You know, I'm giving you. 

About a fifth of a birth control pill is the amount we're giving you when we start you on hormone therapy that little bit. And everybody knows that birth control pills are fine. Um, so, so I think not being dismissive and saying, there's nothing to lose here, let's try it. We might have to try something else, but let's try it. 

Absolutely. Especially for the mood part. Yeah. Yeah. Because nobody can live in anxiety, bad time. Yeah. That's, and it's, it's scary. Dr. Han, I had a question. I, I noticed in the beginning of the episode, you had mentioned that you saw some changes in your mom and that you remembered that. Do you think that that's something that led you into wanting to go into this career? 

You know, you know, as, as early as fifth grade when you wrote, what are you gonna be when you grow up? Mm-hmm. Um, I was going to be a pediatrician that delivered babies. Oh, wow. So you knew. So pediatricians don't deliver babies. So I had that a little bit confused. Okay. But I was gonna be a doctor early on. 

Then I was a labor and delivery nurse coming out of, um, high school. I said, and I was a little too rowdy to go to medical school. I wasn't, I wasn't really being good at that time. So, uh, I went to nursing schools and I was a labor and delivery nurse, thus the love of babies. And I wasn't sure I was gonna like gynecology. 

I loved obstetrics. Well, fast forward gynecology is really where it's at because it's the women in their most desperate times of their life. Mm-hmm. Throughout their decades from, you know, I'm in practice now 30 years, so I've been taking care of women since they were young girls. I always say, you used to come in here when you were a fetus and now you're a grown woman with children. 

Wow. We joke about that. So, um, so no, I don't think that my mom's, uh, moodiness, uh, was a sign to me at that time. But looking back you were like, oh, exactly the right time of her life. Yeah. And a very difficult time for her, but. I wasn't thinking about her. Do you feel like it makes a difference if your gynecologist is a man? 

No. 'cause there's some really good, um, hormone docs Now, I will tell you, it makes it easier if you experience something as a doctor. So if you're a doctor and you have cancer, you're going to be better at, you know, being empathetic about cancer than the doctor who hasn't had cancer. Plus, you can share your story. 

So being a female physician who's had perimenopause and is in menopause, you've navigated the path and you sort of know, tried this, this worked, this didn't work. Let's try this for you. So I'm always a little fascinated by physician, female physicians that are in the menopause whose patients come to me and they say that their doctor said, oh, you know, we'll all get through it. 

And I'm like. You gotta be kidding. Like how can someone suffer through that? But it's a different approach. Yeah. That happened to me actually. I went to a woman doctor and I, I was expressing things that I was feeling. This was a couple years back and she was just looking at me like I was complaining and she just was like, waiting for the appointment to be over, kind of looking at me like, so this is why you came in today. 

Like, you know, I was, I've just felt so like. Dismissed, and I was in shock because I was like, I went to a woman thinking a woman would understand me better. Right. I ended up going back to my original gynecologist as a man. He delivered both of my babies and he was great for that. But like you said, now we get to a certain age where it's like you have a lot of women that come in at their forties. 

And all their needs are different than when they were coming just for regular checkups and pregnancies and stuff like that. There, you know, everybody can't be an expert at everything. You have to pick your passion. But what I wish is that someone would say, um, you know, I don't really know anything about that, but I'm gonna send you to so and so. 

Right. Because this is their favorite topic. Sexual health obviously comes to me a lot 'cause that's the last thing that an OB GYN wants to talk about. It's a long discussion sometimes and you know, they'll just say, oh, go talk to Will Ahan about that. You know, you know, I don't even wanna begin the conversation, but at least they've done their duty to say, I hear you, right? 

You have a complaint. I don't know anything about. People ask me stuff that I don't know about, I usually am then looking it up 'cause I wanna know something about it. Mm-hmm. Because I just wanna speak to it. And then I say, I know who's good at that and I make a referral. Uh, so I think that's our duty as an educator. 

Mm-hmm. Is to say, you know, I'm at a loss here for you. A lot of the rheumatologic stuff, autoimmune disease, very complex. So, you know, I'll say this number is abnormal, and it seems like it needs some more evaluation. Mm-hmm. But this is not my expertise, so let me get you to the rheumatologist or whatever. 

Right? Yeah, I agree with that. Because I think a lot of, if there's someone listening to us right now and they're like, wow, my, I go to my gynecologist and they're telling me, well, that's the way it is. You need to be your own advocate. Oh, absolutely. And you need to find answers to, to what you're feeling. 

And women do do that much more today than ever before. Right. You used to be just the dutiful wife. You know, I remember somebody gave me a booklet when I got married, and it was what the woman did in the 1950s. Meet your husband at the door, make sure you have a nicely pressed dress on. Make sure the children are clean, but quiet. 

And, you know, I giggled through the book going, can you imagine mm-hmm. That women did just this? Mm-hmm. No. Now today women are the businesswomen. Yeah. They, you know. I come in the door here, take my briefcase. My husband does the grocery shopping. It's like that movie Mona Lisa Smile. Oh yeah. Yeah. So they tap into that. 

Today's women are not settling. Absolutely. Well, let's talk about today's women in the workplace. No, because I feel like I hear a lot too that, um, women. Tend to like all these symptoms that we were talking about, fatigue, concentration, it seems like it affects a lot of women in the workplace. Mm-hmm. 

Mm-hmm. And we have like some statistics that show that 54% of employees report fatigue as a major workplace. Challenge 47 struggle with sleep difficulties impacting productivity. 65% say perimenopause negative negatively affects their work performance with 18%. Taking sick leave due to symptoms. Without a doubt. 

Yeah. So you get a lot of women coming in, listen, voicing this, especially women that are working, and especially women in power positions are like, I had a meltdown in the boardroom the other day. I'm laughing because we can all relate in one way or another. I so appreciate you sharing that. And they say, if this continues the rest of my board, which is mostly men are going to kick me out. 

Uh, and they, you know, and they of course recognize their bad behavior. Usually it's just A-P-M-D-D attack, you know, PMS, and they're just saying, you gotta help me or. I'm wearing a suit. I cannot be pouring down sweat when I'm in the middle of a conference with, uh, a bunch of men, especially so bad behavior and women in business. 

But, you know, sleep is number one. If I go after anything, women come in with what they wanna go after. But when I think of what one thing can I focus on that will fix six things, it's sleep. And it's sleep. Maintenance, sleep, they can, they're deadly tired. They're gonna fall asleep in a second. Our watch will tell us our sleep latency is three minutes. 

But then they wake up and then their brain starts turning on sleep rules, everything. Yeah. So if you're having trouble sleeping and you're going through this change, what's something that someone can do to help them sleep? There's lots of ideas. So some people want medication, some people don't want medication. 

Some people want over the counter stuff like melatonin. Tylenol PM is safe during pregnancy. Um, but progesterone has natural progesterone derived from the wild yam, readily available at Walgreens on your insurance for probably $15 for a month. Um. Has a relaxing property. It makes you, helps you stay asleep. 

It's amazing. Some people just say, I cannot believe that. Something as simple as this has changed my life. It can help with a little bit with help hot flashes, but mostly it just gives you a restful sleep. It's amazing. And then there's other sleep meds. I mean, some people have a lot of sleep dysfunction. 

So we really like to hone in on that. It controls appetite and controls libido, right? Sleep comes before food comes before sex. So you better get to sleep. Wow. And you can get something to eat, but you know, sex comes last on the list. So I've got to fix sleep. And what seems to be like the magic number of hours that we should really be getting? 

Probably eight. Really, for me it's nine. My number is nine. Nine is eight. I need 3, 3, 3 sleep cycles. And my sleep cycles are three hours each. So nine hours and it's, so the answer is when you wake up spontaneously? I do. Without an alarm clock. I do. That is good sleep. Yeah. I love my progesterone and sleep also, I, because I've noticed, um, sleep being, sleep deprived also can raise the level of anxiety. 

Oh yeah. You know, so if you are having anxiety and you're not getting restful sleep, it's going to add to the anxiety. Sometimes you may even just get anxiety 'cause you're not sleeping well. Might be the only reason. Absolutely. Absolutely. Uh, it makes you anxious, it makes you hungry, it makes you irritable. 

Um, and then you're trying to get through your next day. Mm-hmm. And just desperate to get sleep again. And now you're more, you know, fog brained. Yeah. You can't concentrate. Yeah, it absolutely, absolutely. Yeah. That's a very good point. I, it's, I would feel like that, like sleep. I, I have always said if I don't sleep well, I don't function well the next day. 

Right. You know, I mean, just forever, I've always been like that. I'm someone that's like, if I don't sleep well, I just don't know what it is the next day. I'm not like getting my job done correctly. Think, you know, I can't remember everything I'm supposed to do throughout the day. When I was married in my first marriage, my husband couldn't stand the beeper going off. 

We had beepers back then at, for my, every time I was on call and you know, we had beepers too. Yeah. Yeah. So, you know, it would be like 17 calls a night if when you were on call, I might have run out three times to do a birth. So he would always sleep in the other guest room. Well, you know, he got comfortable staying over there to sleep and I got comfortable him staying over there to sleep. 

And then I had a good night's sleep. We learned that sleeping separately gave both of us a really good night's sleep. I didn't hear his snoring and he didn't hear my beeper right. Fast forward to my second marriage and my second husband is not a snorer, which is great, but he's a snuggler and he likes to, you know, grab a little of this and, and, uh, and, and likes to just cuddle up. 

But I was so used to sleeping alone for 27 years of marriage that I was like, wow, some nights when I really need that sleep, I'll say, I'm gonna put up a little pillow barrier here tonight, and this is not to keep you away when I hit my nine hours, I'm gonna remove the barrier, remove the barrier, and he gets a kick out of it. 

But I'm like, I need my sleep. I recognize what makes me function and what makes me smile the next day. Right. So, so is there any other supplements that maybe you would. Recommend or the, you know, work well for just all types of, uh, you know, mood swings. Sure. Um, so progesterone actually helps with the PMS too. 

Magnesium. Some people use magnesium, eh, plus or minus on the data there. It helps your poop. So, you know, being constipated, that's is also not a good thing. Which magnesium do you recommend for that? You know, whatever you can get. So there's glycinate. Somebody told me there's a new one, like tar rate or something. 

Think about just getting any magnesium, about 500 milligrams. If after a week of that you're not pooping good, then you go up to a thousand, uh, because constipation, that doesn't feel good, you're bloated. You just are uncomfortable. So, uh, but magnesium also helps you sleep. Um, you know, kava, there's a lot of over the counter. 

Most of that stuff is not tested. So, uh, melatonin 10 milligrams seems to be effective. C, BD plain CBD. Mm-hmm. Whether it's, uh, full spectrum or broad spectrum, uh, does not have the psychogenic property. So you don't have to worry about getting a buzz unless you want one. Oh, that's too bad. That would be the full spectrum, by the way, if you were trying to get that 0.3% chance that there's some THC in there. 

Mm-hmm. Uh, although the Delta eight evidently is much more psychoactive, uh, for sleep, um, meditation, mindfulness, some people have, uh, white noise in the background. Mm-hmm. Don't exercise too close to bed. Of course, do not drink caffeine after 12 o'clock noon. Look at medications. Some medications are stimulating so you have to be careful. 

Um, and then we go with progesterone as our sort of first natural approach in the medication world. And then we add things like Trazodone or um, Mirtazepine. Sometimes. I like hydroxyzine. We use a lot during pregnancy. Um, it's actually an antihistamine, but it has an anxiolytic property. It means it sort of cuts anxiety, yet it's an antihistamine. 

So safe and effective. Great for sleep for any age. That's great. Yeah, that was lot. That's fun. That's great. I love that. A lot of options. Yes. Yeah. That's amazing. And one last. Thing for, well, for the supplements is they're like, 'cause I hear like vitamin, vitamin, vitamin, sorry I can't get the word out. Like, um, B six, I think it is, that can tend to be good for mood swings. 

Obviously Vitamin DB complex in general is your sort of stress vitamin. And it's a, it's a water soluble, so that means you can't take too much. Okay. I do one called B 100. That means there's a hundred milligrams of each of the bees in it. And so you pee out the extras. Your, when your urine is a nice neon yellow, that means you've absorbed plenty and now you're excreting the excess. 

You should take that daily. So good. Be complex daily. Uh, you should all be taking vitamin D. Mm-hmm. Vitamin D three, at least a thousand units a day reduces our risk of breast, ovarian, and colon cancer. So cancer preventer, it's an antioxidant. Um, a multi if you, if your diet doesn't always get what it's supposed to get, you know, a multi is good to have in general. 

Um, those are probably the. Primary ones. Zinc is good for your skin and nails. Some people take zinc. What are your thoughts about creatine? You know, uh, some people are having some elevated liver enzymes with creatine. Really, I think I, I don't know what the, the number is of what you can take. So, uh, you know, creatine is used a lot in protein powders mm-hmm. 

And protein, uh, building. I think that women just need to be consistent with their program lift weight. Right. So the older we get, the more important lifting strength training becomes. You don't have to be chest pressing 30 pound dumbbells on each side. You can do a 10 pound or an eight pound weight on each side. 

It's not supposed to be about getting big, it's about getting toned. Yeah. And keep maintaining your muscle mass. Mm-hmm. Because that's what's gonna burn the calories that allow us to eat more, which is always our goal. I'm glad you said that because I remember meeting a. Uh, a woman a few years ago and, uh, she was about my age and she didn't wanna do weight training or lift weights 'cause she was like, oh, I don't wanna get big. 

And I was like, no, no. Like I tried, but she just refused. She was like, no, I'm gonna get bulky. And I'm like, no, that's not gonna happen. That would be, you'd have to lift heavy weights, right? Yeah. Short reps, heavy weights will bulk you up. Mm-hmm. And little weights with lots of reps will keep you lean and toned and, you know, testosterone, while we talked a little bit about testosterone earlier, uh, and the data is all centered around libido. 

What women will tell you that take testosterone is I happen to be one of those ladies that works out, you know, five or seven days a week and I notice I get more definition in my muscles. When I'm taking testosterone. So even though it hasn't been studied for muscle mass in women there ha they have had studies in like nursing homes looking at fracture risk reduction when they give a little bit of testosterone to the men and women, the little frail people in the, in the nursing homes. 

So we know that it's works around that area. So another reason to consider taking a little bit of testosterone, uh, to enhance your day. A plus. Yeah. I'm ready. I'm in. I want, I want everything. When can I start now? What's Dr? What's your work regimen like? So how do you get it in with your schedule? Oh my God. 

What do you do? So I, you know, I get up at four 30 in the morning. Yep. Uh, because I have a husband that's knocking on the door at that area. Listen, nature is doing its thing. So it's a lot less work for me at that hour. A and b. I can check that box off so I don't have to worry for the rest of the day. 

Happy home. Happy home. Checked off. Exactly. You know, who wants to come home after a podcast at seven 30 at night and have to get naked? I'm thinking about, you know, snuggling and, you know, watching a little something and then putting the barrier up and then putting my pillow barrier up for a little, I'll snuggle for a while. 

And it's funny, I have the, I have the pillow barrier and some nights when I get back from the podcast, he's like, get that. He's a snuggler too. Oh, I get a lot of that. I do spoon. My husband loves a spoon. Oh, I know. Get a handful s. But I'm the same. I like the snuggling. My husband likes the snuggly, but I can't sleep throughout the night. 

Like snuggle for like five, 10 minutes we're done. And then it's just like, you know, like there comes a point, whoever like moves first. That's it respects the other. If I'm gonna roll over now, 'cause I gotta get in a comfortable position like I'm going to sleep even though it takes me like 30 to 40 minutes to fall asleep. 

Yeah. That's my husband's out. In like five seconds. That's it. He'll, he'll tell me something like, oh, tomorrow I want chicken parm for dinner. I'm like, how did you just fall asleep? That's awesome. Yeah. Yeah. So, yep. I think that it's in the gene. And then, you know, the reason I get up at four 15 is after I take care of that, then we work out in the morning before we go to the office. 

Uh, so that's great. Together. Yes. That's beautiful. For how long? Well, I usually can do 20 minutes. He's retired so he can do a little bit longer. All right. Oh, he did exercise before that, that counts. Oh, I roll that hour. Um, oh yeah. So, you know, I can, my morning is very efficient. I I will. Yes. Got the morning right. 

Done. Right. And then I'm going to the office and, uh, the first vagina is at seven 30. So my first patient is at seven 30 and um, and, and, and then the day goes, so it just rolls. Yeah. Uh, from there. And of course at lunchtime I don't do a lunchtime per se because then I certify patients for medical cannabis during that time. 

Right. And then roll back into GYNI have to say something really quick. I noticed in your office, which is something that I really admired. You have a standing desk. Oh yeah. You don't have a sit down desk like this. No. And I thought I saw one day a walking pad. I do. So, you know, I stand a lot. Uh, it's really good for your back when you're standing all day. 

Plus it keeps me on time because if I sit down and start chitchatting with the patient, I may knock it up. Um, the walking pad is super cool, but I have motion sickness. So I learned that when I'm like at the keyboard and, and you know, typing and walking on the walking pad, that sometimes I was getting nausea. 

So I was like, okay. I would get nausea. I need, I can check my email on the walking pad. I can read things, but the typing and moving my fingers and looking at the keyboard, I would get nausea. So I moved the walking pad to my. Uh, computer that basically I check mail or when I do, sometimes when I do, um, telehealth calls, I'll have that thing running slow. 

You just have to be careful 'cause you don't want your head moving you on the treadmill. Does she have a tremor? Does she have a new tremor or, you know, what's going on there? But yeah, the walking pad's sort of cool. Um, I love that. And, uh, you know, of course I have to always shop things and find a great value of a, you know, good motor and. 

Uh, but that, yeah, they're inexpensive. It's like 300 bucks and it's exercise. Just a few more calories, right? That's right. Getting in. Maybe I can have, getting in, getting it in, getting your accepted. Maybe I can have that carrot cake. That's right. Love that. Yeah. So, but I think that, you know, really focusing on your own health, understanding your sleep requirements, because if you get that sleep, like you get, you are a happy person. 

When you wake up, you wake up with a smile and starting your day with that, knowing that you have a whole day ahead of you and, and then you take care of all your little check boxes on the way. Then as the day goes on, you can sort of wind down and enjoy your evening. So, you know, everybody has their way. 

Some people are really energetic in, in the evening. That's never been me. Me neither. Um, you know, I don't know how I used to do that when I was younger. Me too. Um, it's like, how did I stay up till like three, four in the morning? Yeah. No, nine o'clock I'm in bed. Okay. So you, I was gonna ask. Me too. I was counting nine. 

I was like, well, she has to go to bed like at nine. At nine, okay. Yeah. Uh, and sometimes it's eight 30, so. Mm-hmm. That's the beauty of having no children. Yeah. I was just gonna say that. 'cause I actually recently just started trying, I've only, I only did it like maybe four days, waking up at four 30 in the morning, and I noticed that my day was just more productive. 

Like when I got to work, I was actually like in a great mood because I have been awake for hours. Right. I'm not getting there, like just being awake for a few. But it's tough because I do have two small children. Oh yeah. Well, a teenager and, and a. 10-year-old, but they're still young. They need my full attention. 

And I'm like, man, like, and sometimes I'm like, hurry up, I'm telling you guys you gotta get to bed. I can't go to bed until you go to bed. And that's like my song and dance. Yeah. So it's hard. So then there's nights that I go to bed late and then I'm looking at my husband. I'm like, I can't wake up at four 30 in the morning. 

'cause I can't get just five hours of sleep. You know? Because I would normally get up at six. Yeah. But it's just like 5 36 and it's just like I'm still rushing getting the kids trying to get to work and then I get to work and I'm just like Exhausted. Yeah. Yes. Already. So I had that time to myself in the morning and it was. 

It was nice, you know, so I'm trying to get, so I was counting, it was like 4 39, 9 o'clock. Nine o'clock to hours even on the weekends. Yeah. Big partier. We are, uh, even on the weekends and a sleeping in would be six, 6:00 AM uh, we get more done before noon than our neighbors, any of our neighbors. So I think that's the secret though. 

I think it's getting up early, is. Is how people get a lot of things done. Oh yeah. And he likes to go fishing. He likes to push off the dock at seven. Oh yeah. So do that. You gotta get up early, little, little earlier for Wahoo, you know, when you're looking for wahoo, you gotta get out in the dark. Mm-hmm. So, yeah, sometimes it's like, mm, okay, let's go catch some fish. 

But I mean, it is proven. They say that people who are extremely successful are. Already up and at, at 5:00 AM Yeah. Yeah, yeah, yeah. Yeah. I think morning. I think there is something to the personality that mm-hmm. Is a morning person. Yeah. Yeah. They have that 5:00 AM club. Yeah. I haven't read it yet, but it's there. 

There you go. It's true. I am, yeah. I, I, I have to, I wake up at 5:00 AM Yeah. And I just like to have my quiet time before it starts. Right. So, but I think being in, like as, as I went through my forties. I'm 49 now and I feel like I have my sleep. And that's, to have little kids life is gonna change in a few years. 

They have their sound machine and they sleep 12 hours. Mm-hmm. So mommy gets her sleep. But to me it's, it's sacred. Yep. And when I was going through that, like, you know, last year when it was just chaos, I was getting up at three in the morning for no reason with the rumination and it was like, oh yeah, I can't do that. 

No, you, you really, sleep is so important. It's the beginning of recovery from everything. Mm-hmm. So for sure, I need to go to bed more early. I have a really bad habit of going to sleep very late. Oh. What time do you usually go to bed? 1130. Oh my goodness. Yeah. That would be me. That just, that is me tired. 

I'm not tired. Trying to change it. Tired. Yeah. I just Oh, you're not tired. Tired. Oh, that's okay. Well, do you have to get up early? Uh, no, but I'm usually up at six 30. Okay, well that's not too bad. Yeah. That's 6, 6 30. Yeah. Tired. But when you say you go to bed at 11 up, do you fall asleep at 11? I do wake up tired. 

Okay. Yeah. No, I'm saying 11 o'clock. Like you're in bed by 11 or you're falling, you're like asleep by 11. No, I'm in bed by 11. Right. So you're not really going to bed at 11. No. Yeah, 1130. I go, it depends how fast you fall asleep. Oh yeah. I was just gonna saying then finally getting that rem, I don't know, just not tired at that time. 

Yeah. Yeah. That can be tough. Um, what about for women with, um, breast cancer, history of breast cancer or family history of breast cancer? Well, I'm glad you brought up the history of breast cancer. So let's start there. Yes. There is a, um, a word out there that some women believe that just because their mother or sister or grandmother or three aunts had breast cancer, that they are cannot take hormones. 

Mm-hmm. Fact, estrogen does not cause breast cancer. It is the fuel for an existing breast cancer. So if you have breast cancer in your body, it will allow it to grow because the majority of good breast cancers are estrogen and progesterone receptor positive. Your breast developed under the influence of estrogen and progesterone. 

So no surprise that a cancer in that area tends to have those receptors. Mm-hmm. So it's the better kind of breast cancer to have if you're gonna pick one, uh, because we know all the therapies are aimed at. Blocking estrogen and progesterone. But just because someone in your family has, that does not mean you can't take birth control or you can't take hormone therapy because remember, you are far more likely to die from cardiovascular disease than you are from breast cancer. 

Yes, that's a great point. 50 chance. Mm-hmm. That you're gonna die of a heart attack or stroke. Yes. So your life should be focused on preventing heart attack or stroke. Know your numbers, keep your lipids down. Exercise cardio, strengthen your heart. Mm-hmm. All that stuff. So when you're thinking about breast cancer, yes. 

I want you to know what your genetics are. So if you have a mother and her mother had both, both had breast cancer at 40, then I'm gonna send you for genetic testing. Mm-hmm. To make sure you don't have a mutation. 95% of women do not carry the mutation. Most cancers Wow are not because of a genetic mutation. 

I did not know that there's spontaneous mutations. It's just the change in the DNA and it helped it, it created this cancer. So 95% of all cancers have nothing to do with the genetics. Hmm. Wow. But when those genetics exist, BRCA one and BRCA two, everybody's familiar with. Mm-hmm. There's some many others. 

Check. CAGK, uh, pal, B two. There's a whole bunch of them, ATM. Um, when those markers exist, then we are going to be imaging you more frequently, MRIs and mammo, uh, rotating those. Uh, but it still doesn't mean you can't have hormones. Now there's some great articles. I did a talk, uh, to one of the cancer survivorship groups and I thought, oh man, I'm gonna stir the pot with these oncologists. 

But there were, I presented two articles that were 10 years of following women with breast cancer and women without breast cancer given testosterone therapy. Well, guess what? Testosterone is an anti-estrogen, so it does not stimulate the breast to grow. In fact, it would work against breast cancer. So. 

When they looked at the studies, especially in women who took the Arimidex, the anastrozole, which is the blocker you have to take after the cancer, the women in the study had less than expected recurrence of cancer or less than expected cancers overall if they were non-cancer patients. So when I have someone who's really worried about cancer or a patient who has breast cancer, even though they're coming to me to. 

Be living on the edge and wanna take hormones. I say, let's hold the estrogen. You have an estrogen dependent tumor. Let's not give you estrogen 'cause you have a cancer with that feeds on estrogen. Let's start on testosterone and go there. Most of the time, as we've heard tonight, testosterone in itself is a miracle worker for some women. 

I didn't even know that women had testosterone. That's it. I, I'm being honest. I I was shocked. I always say, uh, when women take adequate amounts of testosterone, they understand why their men behave the way they do. Yes, I heard. Yes. Um, so, so, so for breast cancer survivors, uh, we go in the direction of testosterone first. 

Obviously, I ask for permission from their oncologist and you know, it's part of overall wellness. I want them to be exercising. I want them to be eating right. I'm gonna do my part. You do your part, and we're gonna continue you healthy with your history of cancer. For women without personal cancer, that is an estrogen dependent cancer. 

There's no reason why they can't take estrogen unless, of course there's some blood clotting factors like factor five Leiden and people that have had a stroke. People who, um, um, probably those are probably the biggest ones that we see these, these, these markers for blood clotting. Uh, we, we tread lightly there. 

It's a conversation, uh, and some shared risk when we talk about it. It's not a hard no for me, it's, I need you to understand what you're accepting and what's our benefit and risk ratio. And so with those people where, how, what's the approach that they have to take? Um, so for the people with like having a history of stroke or heart attack, and some of them can be young, 48, right? 

Uh, I get them to quit smoking 'cause that's often a risk factor. Mm-hmm. And uh, I usually do very low dose. Again, if I can make them feel good on testosterone alone. But you have to be careful. Testosterone can carry some of those risks. Um, and, and again, it's about overall health. So I make them pull the line on not smoking and exercising and keeping their sugars down low if they're diabetics. 

But, um, transdermal estrogen, taking your estrogen through your skin seems to be much less risky, uh, than taking it orally. So it is not common anymore that I would be starting somebody on an oral estrogen in the menopause. If you're 93 and you come to me and you've been on oral estrogen or Premarin for the last 40 years, I'm not gonna make you change your product, right? 

Mm-hmm. Uh, but uh, if you're a new start, I'm giving you. Transdermal or through the skin. So that could be a gel, a patch, a cream, a spray, et cetera. Are you gonna monitor that person differently because they have like a family history of breast cancer? They're concerned. I mean, I know we've eliminated all the, that's not a factor, but. 

Let's say I'm concerned about that, you know, because I still have like that doubt of like, what if, you know? So do you test monitor that person differently? Well, the person that has, let's say the family history of breast cancer, grandma, three aunts, no genetic markers, but geez, there's a lot of breast cancer on that side. 

Mm-hmm. Um, they're going to, usually when you fill out. There. Some of the breast cancer analysis scores, they're gonna score greater than a 20% anyway. They're more likely to get a breast biopsy because of that history over someone without that history. Um, if they're anxious about it, they're more likely to get a breast biopsy than someone not, so they're already going to, uh, sort of escalate up to a alteration between an alternating, um, mammo and MRI. 

Mm-hmm. So they're gonna get some extra screening and we can always think of a reason to order a screening or a, uh, or a diagnostic test, uh, if we want to. Uh, so yes, we try and, uh, appeal to the anxiety that's being caused, but. The most important thing is that we educate you on where you should worry. And sometimes I say to women, you're spending an awful lot of time worrying about breast cancer. 

You don't have any additional risk. Your lifetime risk is 18%, which is not an increased risk. You should be focusing on your risk of heart attack and stroke. So let's get you doing your cardio or weightlifting or whatever. And I redirect them to their real risk of death. And is there, um, what's the cutoff time of like when you can say, like, like my mom, she doesn't need any more mammograms, but like, how old? 

She's 70. Uh, gonna be 70 mm I would still 72. 72. 72. Your peak risk for breast, your breast cancer sort of peaks at 79 mm. Um, and then starts to come down. If, if a lady comes in and she's wearing sneakers and she doesn't need a walker, I'm gonna have her go and get her mammo. Mm, 80, 85. The data shows that if you could stop mammos at 75 because they're not going to die from breast cancer, from a new cancer that developed after age 75, because it grows really slow. 

Everything does happen slowly after six. My mom got a mammogram two years ago, and she, that was, how old is she? She's 84, so 82. Okay. Okay. And what's the earliest like, like say that you have genetic testing. What's the earliest that a woman should, or, you know, a young lady should get tested? So if, so, if I have a 20-year-old who tells me Mom had breast cancer at 40, I'm gonna order genetic testing on her so that she knows you're gonna do genetic testing, genetic testing. 

If her genes are negative, then she'll start testing 10 years before her mother's cancer. So if mom got it at 40, she's gonna start at 30. Okay. Normally we start at 40. What about if it's not the mother and it's, um, just other relatives? And does it, is it, do you see a difference between if it's the relatives on the mother's side or versus the father's side? 

Yes. We tend to sort of lean towards the maternal side. Mm-hmm. Okay. Um, and we call the aunts and the grandmother's secondary fel, uh, secondary felden. Okay. Sorry, granny. Uh, I don't know where that came from, but, uh, second degree, uh, relatives. Right. So our first degrees are mother, sister, daughter, uh, the second degree family members would be aunts, grandmother, and so, so forth. 

Yeah. So, but multiple second degrees does increase your risk. Uh, so general, starting at 40, back when I was young, it was 35. That's been shown to just be way too young. Mm-hmm. So you had one at. 35 and then you start at 40. Now it's every one to two years in your forties, and then you start, uh, watching more closely. 

At 50, you really start to see the uptick around age 63. The peak is by 79, but statistically one at age 85, 1 in 80 women. At 85 will have or have had breast cancer. Wow. One in eight. So, uh, we're, we're diagnosing it earlier. Mm-hmm. Uh, women are living longer. It's not, you know, the, the overall survival rate is 90, 95% for all comers. 

So I, I don't want women to get stuck there mm-hmm. And bypass important hormones that may make them feel better and get, improve their cardiovascular health and so forth. I had genetic testing done about two years ago because my grandmother on the maternal side, uh, she died at 54 from ovarian cancer. Oh, yeah. 

So that to me was always something in the back of my mind that I was, uh, very concerned with. And I was su surprised that it was affordable and, uh, I was able to get it done and they came to my house, they did it very quickly, and I got the results in about like two days or three days. And you were fine And I was fine. 

I was negative. Yes. So, uh, let's see about, hmm. 15 years ago, myriad was the only one that owned the genetic testing. So a test was $3,500. So I didn't pay that. Yeah. And so, uh, they went to the courts, the other companies went to the courts and said, how can they own our genetic profile? Mm-hmm. And the courts ruled in favor. 

So then all the companies could make genetic testing. And now even if you're out of pocket, it's a buck 50, uh, 150 bucks max. I paid $150. And if you have a first degree relative with, um, uh, a cancer, like a melanoma, pancreatic, breast, whatever, uh, usually that's enough to have the insurance company 'cause it's so cheap. 

Um, 23 and me, these, these tests that people do or they swab, a lot of times mo a lot of them are testing for the same stuff. So if you have a normal, one of those interesting at home tests and you've done the test properly, uh, but it is now, uh, really affordable. So that should not be a reason. What do you think about those 23 and Me? 

Do you like them? Yeah. So the only thing I learned about the 23 and me recently Yeah. Uh. Was because they were, they used that data to find a murder suspect. Oh. Which was the murder that killed all the college girls. Oh. So one of the ways that they, um, found him was they got his DNA from the Starbucks cup or whatever he was drinking. 

They were following around, taking his DNA, but then they ran through all the database on 23 and me, and found his relatives and through his relatives, found out where he lived, who he was, and all this stuff. So I was just watching a recent court episode where the defense was saying, wait a minute, you know, you don't have the right to get into everybody's 23 and me, uh, and just search the data pool for, you know, matching. 

And they said, oh, yes, read that contract. So, you know, when people, you know, sign up and swab mm-hmm. You're, you don't know where you're you. I've never done it because I've always felt like they, they have my DNA. Like what? Yes. That's how I've always felt. So I've never done it. They've already got your DNA, I really don't wanna get a knock on a door from a relative saying, Hey, yeah, can you help me out? 

I think once, I've never done those, but it is, you know, uh, it really does tell a story, but I think when you do those, you check a box that says, I don't want any family members reaching out to me. Right. And I don't, you know, I don't wanna share that, that, well, I know someone who had, well, I would check every box. 

Supposedly a cousin never met him before and started coming to his house and asking him for money. Yeah. Kind of crazy. Of course. Creepy. It's one of those creepy, that's very creepy. Yeah, so I think that, um, the technology is super cool and if you want that information, I have a neighbor who, uh, she did one of those tests and she tested positive for, uh, brca and I said, oh, well, you should be then getting this additional testing. 

And she said, no. And she, she sort of presented an interesting argument. She said, when they tell you that the, with BRCA the risk is 60% higher for breast cancer, they're testing a pool of people that already have a known risk. They're don't, they're only doing the BRCA testing on people who have demonstrated a family history that was risky. 

Mm-hmm. And then you do the test and you find it. Mm-hmm. She said, I think if we just did routine genetic testing across all people, that maybe the incidence of that 60% would be diluted out for all of us. Like her and her mother who had BRCA one who didn't have breast cancer. So they said the pool of characters that you're looking at are already presenting with an increased risk. 

Right. So therefore you're labeling this as a 40 to six. And I thought, huh. I mean, she's got a point there. Yeah. Um, I don't know that I would just feel comfortable not doing anything. Yeah. I would say, uh, maybe you don't have to do every single test, but maybe a little bit of advanced screening, maybe an MRI every other year. 

'cause the breast cancer doubles in size in a two year period. Hmm. Wow. I didn't that good to know. I, my mom had breast cancer twice, so when I go to the gynecologist's test a conversation we have, so she had a recurrence. Mm-hmm. In the same breast? Um, no, the next one Uhhuh. So, uh, and often when you see that recurrence, the younger the girl. 

The more likely the recurrence in five years. The older the person, it's more like 10 years. There's something about that 10 year mark that's sort of crazy. Does HRT in some way protect when, like if they started early in Perry being HRT protect you from breast cancer? No, I don't think any data shows that. 

Interesting. Some interesting points there though. If you took hormones and you did all right, but it wasn't as great as you thought, or the symptoms that were really bothering, you have abated and you decided to stop. If you've stopped by five years on no harm, no foul, nothing's changed, you have not increased your lifetime risk for breast cancer. 

The longer you expose your breast to estrogen. Just over time you've kept your breasts more active by feeding it hormones, then you slightly increase that risk for breast cancer over time. But the idea is that you're, uh, working on maintaining your cardiovascular elasticity and that maybe you're increasing the blood flow to your brain and improving the vascularity and improving your cardiovascular health. 

So people are sort of trying to balance all this. Right. I have a question. Um, for someone that had a hysterectomy done mm-hmm. How does that affect them in regards to perimenopause? So, like, for instance, for me, I had to have an. Emergency hysterectomy when I gave birth to my daughter, ah, sea hyst. Okay. 

Cesarean hysterectomy, yes. Mm-hmm. But I was never given any information after that about what's gonna happen to my body. Right? So, so it, it really depends on what goes on at the hysterectomy. So a cesarean hysterectomy, we leave the cervix and we leave the ovaries. The uterus is bleeding, you gotta take it out, or it's injured or whatever, right? 

Um, so when you just remove the uterus, which is the baby carriage, some of the long-term risks are, um, pelvic support. You might have less pelvic support, but it really, other than the emotional impact of the trauma that you went through, A, you were bleeding to death, and b, you lost your uterus and your ability to have future children because of that. 

Um. That's enough in itself to get through, but it really otherwise does not affect your ovaries. Your ovaries are still youthful, 30 years old, still trucking along doing their thing. Um, so it shouldn't affect your hormonal health directly? Indirectly, yes. All the cortisol and the stress and the trauma a little different story. 

Uh, so it shouldn't, uh, there's some evidence that those ovaries may fail a little earlier because you've had some reduced blood supply to the area by the loss of the uterus. Um, so you might experience menopause at 48 instead of 51. Uh, but it should otherwise be no different other than getting past the drama that took you there. 

Um, when people, people say, I had a partial hysterectomy, so the late term is partial or complete. Um, so what is that? Can you break that down please? Yeah. So removing the ovaries at the time of the hysterectomy is where things go downhill because you're getting put in immediate menopause, right? So when I used to take the ovaries out for whatever reason, let's say endometriosis or something, I would always take patches into the recovery room and put a patch on my patient in the recovery room so that she didn't spend more than a half hour without any hormones. 

Wow. And then if her intent was that she didn't wanna take hormones later, then I could at least wean her off slowly, uh, while she was recovering from a hysterectomy, uh, so that she didn't have this abrupt stop. Also, women who are young, like 35 and lose their ovaries young for. Masses or cancer or whatever. 

Um, they need testosterone right away too, not just estrogen. So the older ones can start with just estrogen and may be fine, uh, when they lose the ovaries. So if you have a hysterectomy and your ovaries remain, that would be considered a partial. In lay terms to us, it's considered a hysterectomy without removing the ovaries. 

Um, then you shouldn't really be any different from a menopausal standpoint. You shouldn't wake up tomorrow and feel menopausal. Sometimes the ovaries sort of spasm a little bit for the couple days. Um, just like when people get chemo, sometimes the chemo shuts down the ovaries for a little while, but sometimes four years later they wake back up again. 

So depending on the age. Okay. And what about if someone ties their tubes? Yeah. Tying the tube tube, that is a good one. Tying the tube is really just blocking the hallway. You've just put a barrier up in the corridor between the uterus and the ovary, which is where the sperm likes to come through and hook up with the egg. 

So that happens in the distal tube and the end of the tube, and then it, you know, walks down the hall and falls into the uterus and implants in the uterus. So tying the tube should do nothing. But girls will say, when I tied my tubes, my periods were the worst ever. I'm just thinking about that, like that egg coming down. 

I'm like, wait. But the periods didn't get any worse. You went off the pill because you tied your tubes and so your periods are miserable because you went off the pill. The tubal didn't do anything to your periods. The tubal was just your freedom from taking the birth control pills every day. But those were doing a good job at controlling your cycle and now you don't feel good. 

So I always tell women when they're having their tubes tied or my husband's having a vasectomy or something, I say, uh, caution. I've had you on the pill for the last 10 years because of horrible periods. You think you're gonna go off the pill and be okay when he has his vest? 'cause that's what he's thinking. 

Um, no, your periods are still horrible. So before you make him get snipped. You better be sure you're not going to wanna stay on the pill, because then he's gonna get mad if he gets snipped and you stay on the birth control pills. Uh, so, so sometimes you have to think about some of those things. Why were you on the pill in the first place? 

He's gonna get mad about that pillow. Well, thankfully, having a vasectomy does not ruin your erection. Uh, many guys fear that it might, but yeah, no, they're not connected, so they're still safe. I know you mentioned, um, exercising and dieting. How, how do you feel about, um, fasting? Intermittent for inter Yeah, intermittent fasting. 

Pause. I think whatever works for you, whatever. So, so if somebody hates to exercise, I'm not gonna recommend exercise. I'm gonna really recommend calorie counting and knowing your numbers and knowing how many calories you burn a day. And if you just like to take a walk, then take a walk. For women like me, I can hold a sign that says, we'll exercise for food. 

So I will do 20 more minutes of, uh, elliptical plus weights in order to have something that I shouldn't have. So whatever fits your lifestyle. So if you can intermittent fast and start eating at 11 and finish at six. Fabulous. That's perfect for you. Just sometimes my intermittent faster, they're eating too many hours, number one, so the whole idea is to eat less hours and two, too close to bedtime. 

You wanna try and have an empty stomach three hours before bedtime. That's really probably the most important thing. So the thing that gets a lot of people in trouble is the snacking at, you know, so when I was young, I would not eat the green vegetables, so my mother would make me sit there until I ate my vegetables. 

I was not eating the vegetables, so I'll sit there as long as you wanna have a showdown, lady. I'm not, I'm not eating my vegetables. And so she would, you know, clean up the kitchen, the rest of the family would go in and watch TV and have a snack and dessert. I didn't get dessert because I didn't eat my vegetables. 

And then it was go to your room, right? Because now the kitchen was clean. She wanted to turn the light out, go to your room. Uh, she actually helped me out there because I never learned to get a nice snack and some ice cream while watching TV with the family before bed. So I never developed that bad habit. 

That's a huge habit for a lot of my patients. That little bit of ice cream or, mm-hmm. Mm-hmm. Especially when you're in perimenopause. Yeah. Yeah. Oh, peruse it. That little, the little back of. The salty, the salt. The, so the crunch. Crunch. Yeah. Crunch. The crunch ion, I love crunch crunching is frustration. Mm. 

Peanuts, pistachios. I mean, you could do a whole container from Costco cashews. Yeah. I love all that. So, of course. And the problem with the nuts is they're fat by definition, so the calories are enormous. Yeah. Where you look at the little pretzel bag and you go, okay, that's like only like 150 calories. Let me chomp on those. 

So crunching is frustration. So understanding what the crunch really means. That's good. Is part of where you're reflecting going, okay, let me get self-centered here. What's frustrating me besides my whole day? Well, I like to crunch on ice, but I notice me too. I noticed that I'm an ice cruncher when I'm a little stressed out. 

I crunch on, on ice. Me too. Oh my gosh. That's, that's great. Is that part of every day? No. No. Not every day. But I, I did notice that. I'm like, I have like the little, you can't go wrong with ice. With ice, but, you know, it made me think of a condition called pica, PICA. Pica pica is people, uh, people crave ice chalk, various things. 

Pregnant women do that. Right. Some, some not. Chalk. Chalk not, not, I've heard of ch The craving of chalk. Yeah. Corn star during pregnancy, chalk crayons. Some kids Doon children. So the, i it's related to anemia. I can't believe that. So the question is. Is it the anemia driving the pica behavior, or is the pica behavior interfering with absorption of things and creating the anemia? 

I don't know the answer, but it's fascinating when people tell you, yes, you know, my uncle's a teacher and he brings home a box of chalk, like chalkboard, classroom chalk, and I eat about 10 pieces of those. Wow. A day. You know, you think about how can that taste that, like, that can't be good, but it's not rational. 

Isn't that like, well, what is chalk made out of? I know. I mean, it's not good. Yeah. I'm thinking your stomach, nothing healthy. Uh, and that's called pica. So it's actually a condition, uh, and it's, it's, mm-hmm. It's more common than you think. Yeah. Mm-hmm. People just don't disclose. I was anemic for a long time, like I was. 

While you were pregnant? No, just like As a person. As a person. Heavy periods. Yeah. Yeah. And I could never donate blood. Mm-hmm. Like that was, they were, no, but I was de, I was definitely an ice cruncher. There you go. Big time. I think it's the anemia that drives the pica for some reason. I feel like when I try and go, which came first, the chicken or the egg, sometimes you really can't tell, but with a good historian sometimes you can see that she was anemic and then developed this behavior. 

Interesting. But having a little ice before bed, you're not gonna have any problem with that. I just figure it is better than salt and vinegar chips. Oh, without a doubt. Without a doubt. I did wanna ask you a question regarding perimenopause. What do you think is the first like real true symptoms that you would consider, for lack of a better word, severe, where someone should say, oh, I, I need to go to a gynecologist or specialist? 

Good question. Um, in your opinion, so severity is so personal about what one person thinks is more severe than the others. There's really nothing life threatening in that list. However, the most bothersome symptoms are irregular periods and. The anxiety and palpitations mm-hmm. Are abound, you know, lots of complaints of that. 

And then the next would be the, uh, brain fog. So I would say, if anything, it's the brain fog, because the brain fog interferes with clear thinking. So decision making could be poor, including your decision making while driving. So if we thought of the highest risk, it might be that lack of sleep and the brain fog. 

Uh, but for the most part, none of the symptoms really lead to anything dangerous, but they surely lead to a poor quality of life. Absolutely. That, that's the magic word right there. Right. Quality of life. Fog brain is, is just, I can't even explain that. Women wanna be able to do everything and, you know, as you know, sitting here ladies mm-hmm. 

They're all very capable of doing it all. But it's very frustrating when you can't, when something's interfering with your ability to control your world, like you're usually very good at. Well, I get to the point where I try to ask myself. Did I always feel like this? You know, like, did I ever not feel like I couldn't think clearly because you get so used to being like, like you said something in the beginning where like one month is, you know, you're a little bit more irritable. 

Next month you're a little bit more moody or the following month. Like, and I feel like that, like, I'm always like, I notice that every other period, um, my mood swings are more intense. So like one month I'm like really, really like just angry and moody and vocal about things. And then like the next month I'm very like, tearful. 

Yeah. I sometimes, yes, I, I definitely would cry, but it's more like I just get numb and I mute and I get like melancholic and I just like, don't, you know? And then the next month comes, and then now I'm back to like, ah, but it, it changes, it fluctuates. And then sometimes I feel like I get one good week in the month. 

Oh. Because my, and not, and I've noticed this myself, like just years of like, just. Thinking to myself like, well, my hormones are getting ready for my period. Then my period comes now my hormones are fixing themselves because I'm not on my period anymore. And then I'm gonna be ovulating. And then it's like I get one good week and I've noticed it. 

'cause I'll be like, man, I feel good. But then I'm like, did I, do I really only have one week? I mean, have I always just kind of felt like, 'cause we've had our periods, you know, since we've gotten them in our teenage years. Yeah. The definition of P-M-S-P-M-D-D says that you must have at least one good week a month. 

And most girls will tell you that is uh, really the week right after their period. Yes. As the period is ending because your estrogen is on the upswing. Mm-hmm. And so we know when that's going to be. Although I make women tell me, and it's, you know, I usually say, you know. Uh, how many good weeks do you have? 

So for the majority of women, uh, their worst week is the seven days before their period, uh, for the, before the onset of the day of their period. For the rest of the group, it's usually the two weeks. Uh, so the progesterone phase, um, but you know, they'll, they, they, so we say, are you tearful and lethargic or angry and aggressive? 

And they'll sit there and go, uh, both, you know, it changes. Uh, uh, I start with angry and then I feel embarrassed that I behave that way. Mm-hmm. And, you know, I used to remember myself during this period and, um, you know, for me it would be driving. So if. You know, you see I drive a Corvette. So if you're in the left hand lane and you know, sitting on the lane and not moving, I might be giving you hand signals back there, move to the right, you know, going nuts. 

And, and then I'd go, oh my gosh, I hope, I don't know who that is. So a pharmaceutical rep, uh, one day came in the office, said, Dr. Wheela, you on OK Boulevard on Saturday? And I. You cut me off and I was like, oh, oh, like did I do this? Was, were you on the left hand lane? And I went, uh, and she goes, that's exactly what you did. 

And I was like, oh, sorry. But you were going slow in the left hand lane. And she said, I was going the speed limit. And I said, well, like I said, you were going slow. I said, let us speeders just go by. And we laughed and laughed, but I thought, how embarrassing. Right. You know, so you get in trouble that way and that, and we reflect on our behavior and say, oh, this is just not me. 

Mm-hmm. I mean, I plan literally my vacations on the Good week. Good, because I, I just, it's not fair to the other people that, no, I'm very irritable. I get melancholy, I cry. And my husband has even said to me, I, that week that you're good. That's when I'm like, okay, let's just go do everything. Game on. Game on. 

And I actually use a free app that's called Flow. Oh yeah. A fellow. Yeah. Mm-hmm. And it's pretty, pretty accurate. And it's free. And that's, that's my little bible. So is it posted on the refrigerator so all the family gets warning? Well, I mean, they kind of already know, but like with all sincerity, like even when I talk amongst people that I, I'm gonna plan something, I'm like, oh no, I can go this week. 

Yeah. You know, because I, I just know my body. But I think another pt, I do recommend that for most women too. Get another pellet, another just get pellet. It'll smooth you through all that. Maybe I'll get two more weeks. Right. I use it for Yap too. Just, just to monitor. It's very helpful. My moods. Yeah. People usually use it for ovulating fertility because they're trying to Yes. 

That's how I, uh, I was using it. I had one too, but, but I'm like, I was talking with a friend of mine, she's like, well, yeah, I just track it 'cause I like to know. Mm-hmm. Which I'm very regular still, but it's my moods that change. So that's what I like to follow. And then I do, I'll look like if I have something for work or personal or I'll be like, oh, it's gonna be coming around that time. 

I might have a little bit of anxiety 'cause I get anxiety right before. Yes, yes. Not as strong. I just get a antsy. Yep. Mm-hmm. I get antsy and I'm like, my period's probably coming And see, I think estrogen helps there. So yet there's really never been a study done to say, if you treat the. P-M-S-P-M-D-D. All the studies on P-M-S-P-M-D-D revolve around the mood management because that's what's getting most people in trouble, is their mood. 

So every randomized controlled trial showing efficacy was showing it with fluoxetine, sertraline, any of the mood. So they work, but women don't always wanna take that because it makes them feel like they're crazy. Uh, they wanna, they know it's hormonal. So why can't I take estrogen? And when I thought of my time exactly where my head was, like this is the lowest period of my estrogen is this week before my period. 

What if I just took estrogen during this period? Uh, will I feel better? And the answer was, I did. So was it a placebo effect? But within three hours of the onset of menses, I would be like, oh, this is like, I'm normal again, because your estrogen was going back up on the next cycle. So there's no harm in giving a little estrogen during that week before your period or the two weeks before your period. 

It's either gonna work or it's not. And if it doesn't, then we move on to the things that the science has shown that works. But so many women get better that over and over again. Um, you know, I say this is why I do this, because it solves a lot of problems and it solves it in the way that the woman would like it to be solved and not the way that's dictated. 

I. I love that. Yeah. Yeah. So you're saying, sorry, I just had one question about that. So you're saying that you don't have to take it daily, right? You can, you can pick throughout the month when you take it, so Right. You feel the effects pretty quickly. Yep. I, I, I didn't know that. So the, the idea on P-M-S-P-M-D-D is, you know, you should be feeling the relief within two days. 

So if your PMS is seven days before your period, maybe nine days, yeah. Before your period. I, back in the day, I used patches, so I would slap on an estrogen patch, estradiol patch, and then I would just set it and forget it. Uh, you know, I just, that's correct to know and. And then you would move into your next cycle and I'd be going, oh, actually I'm feeling better. 

So I don't need that anymore. Um, so I, when I prescribe it, I prescribe a whole month's worth, but a whole month might be one week Every month. Month, yeah. Or four months for somebody. Mm-hmm. Nice. Very good and affordable. I didn't have that luxury of tracking my period for 21 years 'cause Right. You didn't have a uterus. 

Yeah. So when I got pregnant, I lost track. Mm. So 21 years of me just. Not knowing what the hell is going on. Right. Like why, you know, why I feel the way I do. Right. Well, not 21 years, but you know, just for the most part. What was your age when you had the C hysterectomy? 27. Oh, super young. Yeah. It changes your whole perspective on things. 

Well, your girlfriends are going, oh, but you're so lucky because you don't have a period. Well, I felt like that for a while. I was like, yes. Damn, I don't have to deal with that. But then as you get older. You start to think, okay, wait, now I'm hearing all these things and I'm like, wait, what should I, what should I have been doing all that time to help me? 

Yeah. Mm-hmm. You know? So do you know when your mom, uh, went into menopause? No. She had, they don't remember. I know, no. Do you have any older sisters? Mom just says, don't talk about it. I'm the only girl. How old are you? 48. Oh, well you're close. I would just be treating you. You are the easiest one to treat. 

Right. Because the side, the potential side effect of treating somebody with hormones before their periods are have subsided is irregular bleeding. I'm really surprised at how often that doesn't occur. Mm-hmm. You know, because we use both hormones and we know what the effects are. But you're the easiest one because we're not gonna worry about irregular bleeding. 

You have no uterus. Yeah. I mean, I got dismissed by a couple doctors. Oh yeah? Yeah. And the last one was like, no, you'll get cancer. So yeah. I was like, okay. Now you've heard the word. Yeah. Wow. Wow. The science so much for, for science. Everything you've taught us. I feel like the knowledge is so, I feel empowered with the knowledge. 

So glad. Thank you too. Me too. Thank you so much. I just wanna keep talking to you. I know. Aren't all your patients feel that way? We can do this again. No, that that, I love that idea. 'cause we do like a part two. Well, I liked our conversation before the podcast. That was a little Yes, I was gonna say that. Oh, you know, I know it's not appropriate now, but we were talking about some the very affordable vibrators. 

Oh, Mina Kiri. KIRI. Absolutely. And right now it's on walmart.com for $6 day. It's very small and discretion. Amazing. Yeah. Any other questions? I feel like, wow, we really like dove in. Yeah, we, we dove in deep. I think it was great. Yes. Thank you so much. We have full circle. We covered a lot of topics. Would you be willing to come back in the future? 

Sure. Oh my God, yes. We'll make, we'll make it a sex special. Yeah, that's right. Yeah. Whatever. Did you hear that part two guys, whoever's listening, yes. Thank you so much. Thank you so much for coming. What a powerful and informative conversation. So Dr. Willi. Any final thoughts? Any advice, anyone, or recommend? 

Anything you wanna say? I hope what your listeners hear tonight is be your best advocate. If you're getting the answer that doesn't seem right from the person you're asking, ask someone else. And with the these days, you have the Mary Claire Habers online doing all of her blogging, who are actually out there advocating for science-based evidence-based data. 

I love that. Um, you can certainly find lots of solutions that are more interested in your wallet, then the science. Uh, so you just have to be very careful if you're laying out, you know, a couple grand just to feel better, maybe investigate something else, but be, you know, ask. And if your doctor just doesn't feel comfortable with that topic, ask if they can refer you to someone who does. 

'cause they know. Where can listeners find you or connect with you? So the office is located in, uh, lake Worth, but, uh, you know, I, I've posted some fun things on LinkedIn so they can, uh, oh, okay. Search my name. I'm gonna find you on LinkedIn. There's some articles there that really dig deep. Uh, they're fun, they're always humor based, so my approach is always with laughter. 

So this was a perfect forum for me because it is sort of funny, not funny sometimes, right. But it, it really takes it to a different level when we can laugh about the changes and learn how to fix it. So all of my articles always have a little sarcasm or fun or laughter or naughtiness in it. Uh, so there's some fun pieces there. 

Oh, good. I'm gonna find you. Yeah. Well, to our listeners, if you found this episode helpful, be sure to share with a friend who might need to hear this conversation just like today. So, uh, if you enjoy today's conversation, don't forget to subscribe to Red Lips Real Talk and leave us a review. Your feedback helps us continue bringing important conversations like this to the forefront. 

Thank you for tuning in. Take care and keep the conversation going. Thank you. Thank you for listening. Make sure to subscribe to our show so you don't miss an episode. We will be dropping an episode every two weeks. Oh yeah. No, like seriously subscribe now. Suggest chill to the next episode. Follow us on Insta and.