Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Strategies for Navigating Perimenopause
Ever wondered how to navigate the tumultuous waters of perimenopause and menopause with confidence and grace? Discover the secrets to managing perimenopause as Dr. Holly Thacker shares years of expertise and groundbreaking research in the latest episode of the Speaking of Women’s Health podcast.
Learn about the state-of-the-art treatments for abnormal bleeding, migraines, mood swings and the unavoidable concern of weight gain. With the rise of social media influencers spreading menopause information, we’ll guide you on how to discern credible sources and find qualified menopause experts to support you through this transformative stage of life.
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the executive producer of Speaking of Women's Health, and I am back in this sunflower house for a new edition and another pod on all things perimenopause Now, at the beginning of last year's season, in 2023, I podcasted an updated version of my book, the Cleveland Clinic Guide to Menopause, and I wrote my first book in 2007, which was your Body, your Hormones, your Choices, and then in 2009, I did the Cleveland Clinic Guide to Menopause and a lot of the information is the same, although there are some really key updates with new research, new options. When I started in this field years ago, back when I was a resident rotating with my mentor, who's still my friend and colleague, dr Del Boer, a retired OBGYN physician, was in the military, did pediatric gynecology, obstetrics, rei, infertility and urogyne and built the menopause program at the Cleveland Clinic and really was the inspiration for me to open the Center for Specialized Women's Health, which, in part, was because I needed space for my Specialized Women's Health fellows, who are just back from the annual menopause meeting in Chicago, and on our social media I posted pictures of them presenting their research and having an alumna reunion of past and current fellows. Most have gone on to fabulous careers, in part because there's not a lot of clinician scholar leaders in this field. Now some people say, oh, it's because we don't have that much research in women's health, and of course we always want more research in medical conditions and we want gender specific research. But actually we have a fair bit of research on menopause, hormone therapy and, more recently, perimenopause.
Speaker 1:So when I started, even before I opened the Women's Health Center, if someone hadn't gone 12 months without a period or they weren't otherwise diagnosed with menopause by history exam and lab results as being in menopause, we would say bye, you belong in the PMS clinic or some other clinic and come back when you haven't had a period in 12 months. So it's been a long time since we've done that because with clinical experience and with research, with a study of women across the nation, the SWAN study we know that perimenopause can be a very long time and if it's prolonged more than 11 years there's a much higher rate for depression and increased symptoms and not not faring very well. Only 10% of women have a monthly period. That then just stops. Usually there's a lot of hormonal upheaval in that timeframe. Now one of the reasons I think that perimenopause has had its moment in time. It's not because women have not been experiencing this for millennia. They have, and more women have experienced it because, thankfully, in general although not entirely, but our lifespans are expanding that most women in the United States and actually in many parts across the world, can expect to live long enough to outlive their eggs and thus their menstrual cycles and thus enter menopause.
Speaker 1:So prior podcasts have gone over abnormal bleeding. I did that this season with one of our fabulous nurse practitioners, kelsey Kennedy. I have done podcasts on migraine headaches and the biggest concern women have, even though it's not a menopausal classic symptom or perimenopausal symptom, is weight gain. That is probably women's number one concern and that's more a function of aging slower metabolism, loss of muscle mass, less physical activity and the fact that calories are abundant and many times people aren't choosing the right nutrients. I did a podcast on food freedom and how there's so many substances in our American food supply that might help make food last longer and be cheaper or more visually appealing is actually not optimal for health. So if you didn't catch that column on speakinginwomanshealthcom, that's a good one to go back to.
Speaker 1:But again, I think the reason that perimenopause is having its moment is because there's been so much social media and a lot of older millennials and Gen Xers are in that timeframe boomers. Many of them were kind of coming of age or getting to that time of life during the horrible rollout of a very scientific study but kind of unscientifically disseminated the Women's Health Initiative. And so we have this newer generation of women who are very facile on social media and they are getting information from influencers on social media and some of them provide some great information, some of them not so much. And it's amazing to me the number of new patients, probably patients, probably. You know I get most of my patients through word of mouth or reputation. Also physician referral, but I have to say sometimes I'm a little bit disappointed that I get more referrals from Instagram influencers who, when some of their followers contact them because they want to see a menopause expert, they just say, oh, go on menopauseorg and look for credentialed menopause experts, which in general is fine advice and people do, and they put in their zip code and they come to me or some of my colleagues.
Speaker 1:I would like to actually hear that. Well, someone forwarded me the Speaking of Women's Health podcast, or to actually hear that. Well, someone forwarded me the Speaking of Women's Health podcast, or I was on speakingofwomenshealthcom, or I just did a you know, a organic Google search and and came up with a professor of medicine and OBGYN and reproductive biology, or saw your publications or your history. So there's all different ways people get to, hopefully, the right physician, and sometimes it takes way too long, especially in this realm. So that is a good tip. If you're listening to this and you're trying to find someone who's an expert in this area, at least it means that they've taken the time to read a textbook on menopause and take a test and get a passing score.
Speaker 1:I still think there's other things to check out in terms of physician or APP's expertise, and I guess the reason I'm a little bit hesitant about like endorsing oh it's great, you know all these online influencers is many of them are selling things and, as I always like to tell my listeners and my patients, I'm not selling anything. This is a nonprofit speaking in women's health. That submission statement is to empower women to be strong, be healthy and be in charge, and, as a physician at the clinic, I am a salaried physician, so, um, you know, I I don't benefit personally, financially, from influencing someone to buy a supplement or take a treatment and unfortunately, as we've had another podcast on pellets and unregulated hormone therapy and what really is bioidentical yes, we can prescribe it, but a lot of times it's used as a marketing term I think that women need to be critical thinkers and not just get wrapped up in what they're told. Everybody wants thicker hair Our hair podcast or some of our most popular podcasts everyone wants to be healthy and have energy and be thin and have a good sex drive. So when someone's promising you all that and the moon, um, it might be time to take a step back.
Speaker 1:So, getting into the bulk of perimenopause, it's the time period before menopause and menopause is just this one moment in time which is the final menstrual period, or would be the final ovulation, assuming there's not a uterus to bleed. And the classic menopausal symptom is hot flashes, or hot flushes, which you can see the redness come from the chest all the way up, or hot flushes which you can see the redness come from the chest all the way up. But many women will complain of weight gain, joint pain, lower sex drive and a lot of women are really stumped by the lower sex drive and we've had a number of podcasts on sexual function, on treatment of genitourinary atrophy and breast cancer survivors, which is so important, treatment of genitourinary atrophy in breast cancer survivors, which is so important, and that whole topic applies to really all women. There's really no reason why, regardless of your medical history or family history, that post-menopause you cannot have a healthy vagina and that's very important for the whole pelvic floor and bladder and the whole genitourinary system. But the vasomotor symptoms can actually be worse in perimenopause Now joint pain or joint stiffness. There are estrogen receptors in the cartilage, in the bones, in the tendons, in the ligaments. Certainly knee Osteoarthritis can accelerate faster in a low estrogen state.
Speaker 1:Women may notice that they're entering perimenopause because if they're not on any hormonal contraceptives or they don't have a progestin IUD like, say, a Mirena or a Lylata or a Kylena, they may notice their cycle changing. They may start having periods that are closer together or heavier or clottier, which usually means low progesterone. Perimetopause is sometimes dubbed the second puberty and women might start getting acne from surges in adrenal hormones and stress hormones. The stress hormones and the hormones coming from the adrenal gland can drive cortisol levels which can make someone feel more anxious, hungrier, put weight around the belly. Some women actually start to even lose bone density because the estrogen levels dip so much.
Speaker 1:Now, not all women have periods. Some people have a hysterectomy but still have their ovaries or had an endometrial ablation or has a have a Mirena intrauterine system. If you're one of those women, if you're in your 40s, 50s and you feel, but you're not having a period, I think it behooves your women's health clinician to check your FSH and estradiol, because not everybody's wired to flash or have symptoms. But internal things can still be happening and you really want to date the age of menopause. So you may ask how long does perimenopause last? Well, for the average woman it's about four years, but for some women it can be very rapid, in only a few months. And for women that are on hormonal contraceptives, they may not know that they're in perimenopause because they're getting a good dose of hormones that suppress their pituitary, which does not tell it to try to make an egg, and it already perceives some estrogen in the system. So the average age of perimenopause is about 45 to 47.
Speaker 1:The range of menopause normally is 40 to 60, although most people are 45 to 55. If you have a true menopause before 45, we consider that early. If it's before 40, which happens to 1% of women, it's abnormal and you definitely need evaluation and treatment. Some women will go past 55. A later menopause is associated with a longer lifespan. Some women still have ovulatory activity and hormonal cyclical bleeding until they're 60. But most physicians, if you're much past 57, even if it's a regular cycle period, they want to rule out abnormal causes of bleeding. And anytime you go six months with no bleeding and you think it's menopause and then you bleed, even if it's a regular period, it's technically abnormal. It's technically postmenopausal bleeding and we don't want to miss hyperplasia, infection and especially endometrial cancer.
Speaker 1:So you have been listening to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, and we're talking all things perimenopause, which is such a hot topic in the media, on social media, amongst women's groups, discussions at book clubs. I think it's great that women over 40, even some over 35, are starting to think about this, learn about it, research about it, and for so many women I see them completely caught off guard. They're educated. Maybe they knew a lot about pregnancy and delivery and breastfeeding topics we've had podcasts on as well and they feel educated about their contraceptive choices and then they think they're past all of that, it's going to be just smooth sailing after that childbearing. But for a lot of women it is a rude, rude awakening and people come to me and they want me to be able to tell them what to expect, and we don't have a crystal ball.
Speaker 1:I like to find out about the family history. I think everyone should know about their biological family history if they're able to. But I have lots of patients who've been adopted. It's a wonderful gift for families to be able to start a family through adoption. So not everyone always knows and some families and cultures don't really like to talk about those things. But if you're able to get that information from your mom or your older female relatives, while they're able to give you that information, I think it's great. It doesn't tell the whole story but it might shed some light.
Speaker 1:Symptoms to be aware of that can appear during this time frame include hot flashes, sudden sensations of heat or cold or sweating. It's usually from the neck or chest up. It's usually from the neck or chest up. There can be breast tenderness from rapid fluxes in hormones. Night sweats are the same thing, basically as vasomotor symptoms. They just happen at night and some women are drenched more with temperature changes as you continue to get older and have more ovulations.
Speaker 1:If you're not suppressing ovulation, you could have worsening of your premenstrual symptoms and if it's severe, it's termed PMDD premenstrual dysphoric disorder and I like to talk about it because it affects about 10% of women and it can cause intense emotional and or physical symptoms, which classically occur right after ovulation and last until menstruation. And after menstruation there's relief. There can be irritability, bloating, breast tenderness, headaches, poor sleep, and the major difference between PMS and PMDD is the severity of the symptoms. Some women can have a lot of anxiety and mood changes and even depression. Now women that already suffer from anxiety and depression, who just get worse premenstrually they still have their underlying problem of anxiety and depression with premenstrual exacerbation.
Speaker 1:So it's very important to track your symptoms with a menstrual symptom tracker and that's how we really diagnose it and keeping a calendar of your menstrual blood flow. Even if you're not concerned about pregnancy, because maybe you've had a tubal ligation or you're not sexually active with anyone who can impregnate you or your partner had a vasectomy, it doesn't matter, we still want you to track your cycle. It tells us a lot about your health and hormones. We do have some hormones that are FDA approved to treat PMDD. They're in the hormonal contraceptive class of medicine with the progestin, which is really a spironolactone analog drosperinone. So Yaz, yasmin, safral, biaz are in that class. We have non-hormonal options which are in the selective serotonin reuptake inhibitor class. Serifem was just a lower dose of Prozac fluoxetine that was approved, I think, well over a decade ago.
Speaker 1:Uh, some women feel a lot more fatigue and notice weight gain and fluid shifts. Certainly, uh, evaluating for sleep disorders like sleep apnea, vitamin and mineral deficiencies, poor diet, poor lifestyle Uh, that goes a really long way and I think looking at all of those things with your primary care physician or your local gynecologist you should do. Calcium is one of our first line mood stabilizers. A lot of women don't get enough calcium, particularly if they avoid dairy, if they're lactose intolerant. If you haven't heard the podcast I did on cholesterol and blood pressure and cheese and how their cheese can be good for your health and there's lots of differences between the different cheeses that are available Get your calcium and your omega-3s. Most all women that I check their omega-3 fat levels. They're lower in omega-3 and higher in the inflammatory omega-6 fats.
Speaker 1:So if your cycle changes a lot, it needs to be evaluated, even though it might be hormonal. And any erratic bleeding, heavy bleeding, unexpected bleeding can be easily evaluated by your gynecologist, your women's health clinician or your women's health nurse practitioner, and usually it includes an exam, a pap smear, sometimes an endometrial sampling in the office with a tiny little three millimeter pipelle. When I was having some abnormal perimenopausal bleeding I came to my GYN office with my own gyno sampler because it's a little firmer tip and that's what I like to use in the office as opposed to this flimsier uh pipe hell, because then a lot of times you don't have to dilate or use pinchers or do things that are a little bit more uncomfortable on the exam. Um, and we need to rule out infection and precancerous lesions. 1% of the time it can be cancer. A lot of times there's polyps or uterine fibroids.
Speaker 1:It's very common for women in their 40s to have the need for even a DNC, although with advances in office hysteroscopy, which we talked about in the abnormal bleeding podcast, sometimes this can be avoided. Sometimes women have bleeding disorders that only get manifest after they've stopped childbearing, being on hormonal contraceptives. For instance, von Willebrand's disease needs to be considered. Women can develop vaginal dryness from drops in estrogen, even if they later have surges, and women who start to lose some of their adrenal function, if they've been stressed for a long time, had prolonged perimenopause, maybe they've been on prednisone or they have autoimmune conditions. If you've noticed that you've lost your underarm hair and pubic hair and not because you had it lasered, ladies in fact I don't recommend that I know a lot of women like that for cosmesis but I like to know about the status of the pubic hair and the underarm hair, because when you start to lose it, it can mean that you have lower adrenal hormones which help support the genitals.
Speaker 1:Now, as I've said before, the purpose of a sex drive is to reproduce, and certainly that's great. Sex drive is to reproduce, and certainly that's great. We want people to reproduce. Our birth rates are really in the tank in the US. A lot of people wait a long time and there's never really a great time to become pregnant in terms of you know, you can never have enough time, enough money, enough support, but it's a great thing to do. I just got back from seeing my nail lady and she was so happy to tell me that she was finally pregnant. She'd been trying for years and I was getting her set up with different fertility folks and it was just exciting. Everybody gets very, very excited with a new life and new babies.
Speaker 1:So um many adults enjoy um sexual activity and there are health benefits, and so when that drive for sex goes away, it can be very jarring and there's a lot of hormonal contributions to driving you to have sex. So when you lose your sex hormones, you can lose your sex drive. And that doesn't mean there's not other issues intimate personal issues or other medical issues or medication issues, partner issues so there's a lot of things to tease through and we've had podcasts where our executive producer, lee Klikar, has interviewed one of the sex therapists we had. We had two sections series on that, which is really excellent. I think going through a lot of these things before you seek out a medical opinion can be very helpful, but a lot of times it's because of pain and dryness or because of absolute lack of hormones, although usually you're still making hormones.
Speaker 1:If you're bleeding and you're still having periods and you're in perimenopause, maybe you're just exhausted because you've had terrible hot flashes and you haven't got a good night's sleep and difficulty sleeping. We've had several podcasts on sleep. Sleep is so important. Lack of sleep is a form of torture. I know I feel better in the morning. If I wake up and I never even got up one time to urinate I am ecstatic. We tell people it can be normal to get up once at night. If you're doing it more than that, it should be evaluated, because sleep helps refresh and regenerate your body. Now mood swings can get more intense when someone is short on sleep, having other bodily symptoms, not having enough time in themselves.
Speaker 1:A lot of perimenopausal women are in the sandwich generation, caring for older relatives and younger children and still working and trying to keep up with community commitments and family commitments and home commitments. I think that women sometimes need to just say no, to space things out, to ask for help. A lot of women seem to need that permission to do that. Now. Skin changes like dryness or even acne. Women say I'm getting wrinkles and acne at the same time. It's not fair. Women can notice itching, maybe an increase in hives if they're more histamine sensitive, a loss of some of the elasticity, especially if their estrogen levels really dipped. Heart palpitations are another symptom, but we always have to rule out cardiac problems. We can't just attribute it to perimenopause, but that has to be thought about in the evaluation and it's just a vasomotor equivalent. But it's very scary Migraines If half the population has migraines.
Speaker 1:If you're a migraine sufferer like I am, please go back and listen to my migraine headache podcast. I sent that to my 19 year old niece, nene, who really got an uptick in migraines when going off to college. So a lot of things can affect that, but hormonal fluctuations really do. Women, if they're genetically predisposed to hair on the upper lip and the chin or a little thinning in the typical male pattern areas, might notice that as their estrogen levels are dipping. A lot of women come in and tell me I have brain fog doctor, I can't remember that word I was trying to think about. And estrogen is very important for brain function. Acetylcholine, neuronal health uh. So up and down hormone levels, lack of hormones uh. Poor sleep, increased stress, is not so good on the brain.
Speaker 1:A lot, lot of women turn to alcohol to try to deal with their symptoms, relax them, which all it does is interfere with their sleep and cause more weight gain and elevated blood pressure. So we see a lot of that constellation at midlife and women who have relatives that they may be caring for with Alzheimer's. When they start to see their word finding, issues happen. Many of them come straight to the physician terrified about Alzheimer's. And some women can describe lack of motivation, maybe if they've had attention deficit disorder, and then that's not being treated and they compound it with lack of sleep and lack of estrogen. That can make it worse. So if you're having these symptoms, you want to get evaluated hormonally, nutritionally, sleep wise, all of these, these things.
Speaker 1:Now a lot of women ask me how do I know if the changes in my periods are normal or if it's something I should be concerned about? If there's a change and you're over 40, it should be evaluated. It's not normal to bleed irregularly. Some women may bleed when they ovulate because the lining's gotten too thick. We need to evaluate and treat that. It's not normal to bleed after sexual activity. If you're spotting that could be something wrong with your cervix. If you haven't listened to our podcast on cervical cancer screening, that's so important.
Speaker 1:I see women not get their pap smears. Since we've gone to longer lengths because we check for HPV, women are just forgetting about the need to get their pap. I would say a third of the women I'm seeing. They can't even tell me when they had the pap. Oh, it's over five, six, seven years ago and I've seen cases of cervical cancer in women who had a normal pap at HPV and they're four and a half years out. So I know that it said you can go five years, but some of these recommendations are like the bare minimum. It's not necessarily what I get done. In fact I've got an upcoming appointment with my nurse practitioner to get my pap smear. Even though I've always had normal pap smears, thankfully, and never had HPV, still I want to get checked and so I think every three years over age 30, for a lot of women is actually more appropriate. And now that women are getting moranus that last for five years, that now they're being told last eight years. For contraception they don't last eight years for protecting the uterus. If you're using any estrogen and perimenopause, I will say I only give you five years. And for contraception we've seen products of conception at seven and eight years. So I personally would not go that long.
Speaker 1:But this podcast is not medical advice. It's just information to help empower you and to give you information and be prepared and organized for that visit with your women's healthcare clinician. 80% of women can have fibroids. There can be undiagnosed pregnancy. There can be hormonal abnormalities, uh, blood clotting disorders and rarely, but still 1% of the time cancer. So, ladies, if you're having abnormal bleeding, make an appointment, get it evaluated. You're worth it. I usually check thyroid function if there's abnormal bleeding, if there's migraine headaches.
Speaker 1:And, yes, you can get pregnant even if you are done having your family. You already have your, maybe three, children and you don't want to get pregnant. Maybe you skipped periods and had hot flashes. Maybe you've suffered from infertility and never thought you could get pregnant. Now you have a new partner. I have seen it all. So until you go 12 months without a period and are clearly diagnosed as being, uh, in menopause, not perimenopause, but in menopause you should use some form of birth control if you don't want to become pregnant. And so, um, for women who've never became pregnant and they're in perimenopause probably need to see a fertility expert sooner rather than later, if that's what you want to pursue Now.
Speaker 1:In terms of treatment for perimenopause, it's a lot harder than treating menopause. So when I have a woman in my practice who's in menopause, it's easier If I have a woman who's in menopause or perimenopause and doesn't have a uterus, that's even easier because we don't have to worry about the bleeding problem. Not that I'm suggesting rush out and get a hysterectomy. We did too many of them in the past. However, now I think the pendulum swung the other way and sometimes we're doing too much to save a diseased uterus. So you know, if you have a lot of pain and bleeding and fibroids and you've had procedures done and you know things aren't sorting out, then you know it might actually be time to consider a hysterectomy.
Speaker 1:And we've had podcasts on abnormal bleeding and whether you need to see a minimally invasive gynecologic surgeon. But for those people that aren't there, sometimes using systemic hormonal contraception whether you need contraception or not can actually treat perimenopause because hormonal contraceptives are strong enough to control the brain. One of the hormonal contraceptives that's actually FDA approved to treat perimenopause and abnormal bleeding and actually has a natural bioidentical estradiol in it is Natasia, and I've had trouble prescribing it because a lot of healthcare plans haven't covered it, but recently it's gotten a little easier, so that's excellent. Every couple of days there's a different dose and the last two pills are just a little bit of plain estrogen and that's when the bleeding happens and it's designed to try to help stabilize that endometrium. For people that are sensitive to hormonal shifts and migraines it might not be the best option. One of the newer options we have is Nextellus, which is a natural estetrol E4 with drosperinone, which is very mood and weight and hormonally favorable and I find that helpful in women.
Speaker 1:But if you smoke and you're over 35, if you've had blood clots, if you haven't tolerated synthetic progestins, then that's not an option. Luckily a progestin-only IUD can be like a Mirena which releases levonorgestrel a synthetic progestin many times can help stop abnormal bleeding and it's actually Mirena is FDA approved for abnormal uterine bleeding, even in someone who doesn't need contraception. Sometimes we'll use oral natural cyclic progestin progesterone like Prometrium if there's no peanut allergy and we try to time it after ovulation and this is more helpful for women who are having heavier and clottier periods. Uh, depo Provera is a synthetic injectable progestin Um, and we sometimes might use this to control bleeding in someone who can't use any oral estrogens because of a history of a blood clot or thrombophilia, or women with vascular conditions or really pretty serious autoimmune conditions, as well as women who smoke after the age of 35. Now we can use menopausal hormone therapy in smokers. We still don't want you to smoke or use nicotine or vape because of a lot of different health reasons. We still don't want you to smoke or use nicotine or vape because of a lot of different health reasons.
Speaker 1:However, um cyclical menopausal hormones are usually not strong enough to control bleeding in early perimenopausal women and a lot of women think they're in perimenopause but aren't. They have symptoms. They may have fatigue and headache and depression and joint pain and weight gain, and it might be due to lifestyle issues and other medical issues and not perimenopause. Now there are some non-hormonal options to control heavy bleeding, like meclaphen is the brand name of an oral non-steroidal that can relieve painful cramping and bleeding. Lystata, which is the brand name for transamic acid, is used for heavy bleeding in women who are not using hormonal contraceptives. There are some doctors who might use both together. I prefer not to, but it can help reduce blood flow. I frequently offer women over-the-counter B1 thiamine 100 milligrams to help relieve cramping.
Speaker 1:Non-hormonal options for mood symptoms, like low-dose paroxetine. Brisdell 7.5 is FDA approved for hot flashes and Vioza is a non-hormonal option, but I only use that in menopausal women, not perimenopausal women, and we've had several podcasts last season, including CME for medical credit for physicians. On the NK3 antagonist, flubanserine Addy was FDA approved several years ago and I wrote about it in my first book I wrote in 2007. It is a non-hormonal option that actually improves sex drive in 70% of women and it helps sleep and it doesn't cause weight gain. Most insurances won't cover it, so someone has to really be motivated to try it and it has to be used for at least oh, at least 60 days and then, if it works, I usually say six months.
Speaker 1:We have other mood medications and anti-anxiety medicines that sometimes might be needed. I usually will check zinc and B12 and vitamin D and omega-3 and sleep and counsel women on all the issues related to lifestyle and we have had many podcasts on exercise, on healthy diet, on superfoods, on sleep, on weight management, had a whole podcast on vitamin D. We've talked about mineral deficiencies, staying hydrated, stress management We've had great podcasts on that and physical maneuvers such as just keeping your body cool, dressing in layers, um, you know, being open to medical treatment if needed, but still trying to focus a lot on lifestyle and also realizing you need to see your primary care physician at least once a year, if not twice a year hypertension starts this time of life. Sometimes your cholesterol levels go up, uh, when your hormone levels go down. Although, if you don't have heart disease and you're a year hypertension starts this time of life. Sometimes your cholesterol levels go up when your hormone levels go down. Although, if you don't have heart disease and you're a woman, I don't generally recommend statins for primary prevention. So we talk a lot about heart disease and cardiovascular health in many of our prior podcasts. If you want more information about that, many times we'll get an FSH and estradiol level if you're not on a synthetic estrogen hormonal contraceptives, but it only gives us a snapshot for 10 minutes in time. And if you've been on biotin B7, that messes up lots of lab tests. You've been on biotin B7, that messes up lots of lab tests. Occasionally we may get an anti-mullerian hormone and that tells us about ovarian reserve. I think it's important to see your women's health practitioner every year, even if you don't need a PAP, just to kind of stay on top of this and get directed to some good resources, and I just want to thank all of you for joining us in the Sunflower House for another podcast edition of Speaking of Women's Health.
Speaker 1:If you don't subscribe. Hit the subscribe or follow button. It's free. We're on Apple Podcasts and Spotify Tune in. We're on our website, speakingwomenshealthcom. If you have any questions that you want answered, go on speakingwomenshealthcom and put in the question, and maybe we'll be able to do a podcast on it. Thanks so much for listening. Feel free to forward this podcast to your friends and I'll see you next time in the Sunflower House. Be strong, be healthy and be in charge.
