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
Top 11 Women's Health Questions, Answered By Nurse Marissa
Get answers to some of the most common women's health questions, answered by Marissa Walker, a registered nurse from the Cleveland Clinic's Center for Specialized Women's Health. Together, Host Dr. Holly Thacker and Nurse Marissa uncover the critical differences between a GYN annual exam and a pap smear, and discuss the essential role of maintaining personal health records.
They explore the world of women's health screenings and the truth behind common misconceptions. Dr. Thacker and Nurse Marissa guide you through the importance of regular HPV checks and mammograms, shedding light on Ohio's new mammogram reporting laws and what they mean for you. The conversation doesn't stop there—find out why annual GYN exams remain crucial even post-hysterectomy, as we emphasize comprehensive health monitoring.
Join them as they tackle hormone therapy and the complexities of managing prescriptions. They delve into why continuous monitoring of hormone levels is vital, especially for women with specific health backgrounds. Plus, they address the anxiety surrounding test results and the importance of medical guidance over online misinformation. This episode is packed with invaluable advice to empower you to take charge of your health with confidence.
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Executive Director of Speaking of Women's Health, and I am glad to be back in the Sunflower House for a new episode. For a new episode. Joining me on this new Speaking of Women's Health podcast episode is one of our favorite Center for Specialized Women's Health nurses, marissa Walker, and, I think, somewhere in the background, beth, you want to pop up? Beth is my daily nurse that works with me with patients. Where are you hiding Beth? There she is. I love these ladies. They're so great. So a little bit about Marissa. She has her bachelor's of science in nursing and she is a registered nurse and she is a nurse in the Center for Specialized Women's Health at Cleveland Clinic in our OBGYN and Women's Health Institute. Marissa is a mother of two boys. She's a boy mom, like I am, and her boys are so cute. You just want to pinch them. They've had fun meeting my granddaughters and Marissa and I kind of share a guilty pleasure with nails, right? Oh, yes.
Speaker 2:Yes.
Speaker 1:And sometimes we'll post both of our hands together on our Speaking of Women's Health social media. If you don't follow us on podcast or if you don't follow Speaking of Women's Health on our Facebook or X, formerly known as Twitter, or Pinterest or LinkedIn, we're also on YouTube and Rumble channels. So if you're listening to this podcast and you want to see Marissa and her pretty eyelashes, you're a girly girl. I see Beth sneaking out, probably to get some patients ready for clinic. Anyway, welcome, Marissa. We're so excited to have you as a guest on the Speaking of Women's Health podcast to talk about a lot of the common questions that you field every day. You work as a facilitator with Dr Batour's virtual shared medical visits. You work in triage, so tell us about some of the work that you do in our center and some of your areas of expertise of the work that you do in our center and some of your areas of expertise.
Speaker 2:Oh yeah, so background, I do have experience in emergency medicine, labor and delivery, and I've been in gynecology women's health menopause for the last three years, now Coming up on three years.
Speaker 1:You're a very smart cookie and you also have expertise in helping a lot of our patients who get bone infusions and you do nurse visits as well. Yes, yes, so we're going to go over some of the common questions that I think you field most every day. So tell our listeners what's the difference between getting a GYN annual exam and getting a pap smear?
Speaker 2:Oh yes, now this question is so common because I know back like not even about maybe five or six years ago. We used to get our paps in our annual exams, like at the same time every year. Because medicine is changing, these guidelines are changing, we have to change things up from time to time. Common misconception is that you have to get a pap smear every year. They found that you don't have to get it that often. A pap smear is a gynecological test that will screen for cervical cancer and we tend to do it typically every three to five years. Now an annual GYN exam that's going to consist of your breast exam and your pelvic exam and that will be done annually, hence the annual yearly every year. So a pap smear is just something that may occur in one of those years, but not necessarily every year, unless there is something that needs to be followed up on.
Speaker 1:And that is such an important point and I find a lot of my patients think they had a pap smear simply because they saw a woman's health clinician or a gynecologist and had a speculum put in the vagina to look at their vagina and cervix.
Speaker 1:It doesn't mean that it was scraped. And for our listeners who haven't heard, the interview I did with Dr Sharon Sutherland, who is a gynecologist and she's in charge of our cervical cancer prevention program and the head of our gynecology ultrasound, which we may talk also about, since we order lots of pelvic ultrasounds that's a good podcast to go back to listen to. And the thing that I emphasize to a lot of my patients and new patients and I know that our whole team, like our administrative assistant, julie Stahl, who's been on our podcast to talk about how to get an appointment at the Cleveland Clinic, is she'll send out messages on MyChart asking people and women to bring in their records and bring in their actual pap smear results and keep copies so that we have them Because we can't see, even if it's an electronic system, of another system. Do you want to talk a little bit about MyChart and how patients access and interact with you on MyChart?
Speaker 2:Oh yeah, so from time to time we'll get a phone call and that will be like through our admins. They'll leave us a message and we'll get back to them, usually within 24 hours. And then if there's a question non-urgent or non-emergent, um a medical question our patients will type in that question in my chart and we'll answer it now. Sometimes it does take up to about three days to get a response, typically for that, because we have such a like large patient flow, um but um, we get questions that have to do with um menopause concerns, like symptoms that one may be having, or questions about their medication, about refills, trouble getting their medication from a pharmacy, like pretty much anything. It's like a large range of questions that we get.
Speaker 1:Yeah, you get a whole wide variety and I know that the other day, uh, when lead nurse Alexandra was there, she was like there's not not anyone in triage right now and everybody's box is overflowing and there's hundreds and hundreds of questions, and so our nurses just really work so hard and that's one reason why I'm so grateful that we're able to put out so much great content on Speaking of Women's Health, to empower women to be strong, be healthy and be in charge, because a lot of these answers. I bet people could go on our speakingofwomenshealthcom website and just type in and get some simple answers that they need, as opposed to overly relying on the nurses. And certainly for emergency situations, people need to call 911 or go to the emergency room for heavy bleeding, you know, chest pain, those kind of things. I think it's very important for people to understand how to utilize electronic secure communications with their healthcare team, how to utilize electronic secure communications with their healthcare team, and I do believe that the clinic has instituted sometimes charges for MyCharts. Is that right?
Speaker 2:That is correct. So if there is a MyChart message that requires more time from the physician or from the advanced practitioner, then generally they will charge a certain amount to the patient's insurance. To answer that question, because it just kind of counts, it'll be like equivocal, to like a telephone visit or a virtual visit almost depending on how sensitive the question is.
Speaker 1:Yeah, yes, yes, and so that's why I think this podcast is so important to go over a lot of questions that maybe people can get answered ahead of time and not have to, you know, go online and wait, you know, a few days to get an answer. So this other common question is my doctor states that my pap smear was normal, but on my chart it says yes for HPV reflex. What does HPV reflex mean, nurse Marissa, yes, Okay.
Speaker 2:So HPV is a STI or STD that we test for. Generally when we do a PAP it's automatic for everyone after the age of 30, as of right now. So reflex just means in the event that something is abnormal, we will go and test for this item. So when you get that message that says hey, yeah, your pap smear was normal follow-up in the year, you're fine to go. It does and you see the reflex, yes, hpv. It's just meaning that in the event that you would have had an abnormal pap smear, they would have saw some atypical cells, some cell irritation on the cervix or some low-grade cells on the cervix, anything of that nature. They'll go ahead and test to see is HPV the culprit of that? We'll test for it, but it doesn't necessarily mean that you have it to indicate whether you have HPV. Your actualV test you'll see where it will say detected or not detected. You will go by that.
Speaker 1:Excellent that is so excellent. And most all women do get exposed to HPV, even if they only have one sexual partner, and most people clear the infection. So 80% of women have been exposed by age 50. But sometimes if your immune system is bad, it can come back out. There's other causes, especially in midlife women, of abnormal PAPs. Particularly if they're low in hormones. The cells can look abnormal.
Speaker 1:So it's very important to get this periodically checked and I'm a big proponent and I know a lot of our APPs.
Speaker 1:Like we've had nurse practitioner Dana Leslie on in the past and I think hopefully we'll have her on in season three again. And we've had other nurse practitioners who are excellent, like Kelsey Kennedy and Babs Alex Babushkak as well, to talk about their advanced practice, nursing practice, and we usually try to do a pap every three years, like I was just in to see Dana myself, because five years is a long time, and so I think if women have gone definitely more than three years before they've had the scrape and the HPV that they should talk to their women's health team about, well, maybe I should get another one, because maybe they won't come back within that five-year mark and we really do not want to miss cervical cancer for sure. So let's move on to the upper part of the bikini area, the breast area, and a lot of women I'm sure that you talk to all the time are having breast pain and they wonder if they need a mammogram. And so talk a little bit about how you handle that from a nursing perspective.
Speaker 2:So I think it's just like a common misconception as soon as you have any type of breast pain you need to automatically get a mammogram Like Cleveland Clinic, we have a very impressive breast center.
Speaker 2:Like Cleveland Clinic, we have a very impressive breast center. So when someone is having pain in like these locations, we have these specialized centers for like almost every body part here. So we do have a specialized breast center which we do like from time to time network with and trade notes with. So in the event that you have breast pain, we wouldn't automatically give an ultrasound or a mammogram and I didn't want patients to think that it's neglectful on our part not to give you a mammogram because you have breast pain right, because it could be due to anything and we want you to get that thoroughly checked out. So in general, we would generally refer you over to the breast center to get further follow-up. Like, yes, a GYN can look at breast and pelvic, but if you want someone that specializes in it to get a more detailed examination and like diagnosis and referral to what you need, it would be recommended to go to breast center. So generally we'll start with that.
Speaker 1:And one thing of course it can be from hormonal fluctuations.
Speaker 1:I've seen a lot of women since we've been checking omega-3s and seeing a lot of people are getting too much of the inflammatory omega-6 fats and not enough of the omega-3s that a lot of women are just taking fish oil and we've got podcasts on nutrition and diet and omega-3s and I've seen women develop breast cyst and breast pain from too much omega-3s, even though a lot of people don't have enough and just hormonal fluctuations wearing a good support bra, and so that doesn't necessarily mean cancer. But we have new legal requirements in Ohio law in terms of reporting out on mammograms and so I'm sure you're going to if you're not already getting lots of questions from women. It's getting much more detailed about whether their breasts are dense or not, whether they have increased risk for breast cancer, whether they should have more imaging, and there's a lot of women who kind of fall in this gray zone and I'm sure that's going to generate a lot of confusion and questions and I really like to direct to our patients to our speakingwomenshealthcom site because we have a lot of proactive information about breast health, reducing breast cancer risk and who are those high-risk people who do maybe need more imaging, like ultrasound or MRI, or maybe even need to see cancer genetics, and we do have a large population in our center of women that have genetic mutations that do make them at higher risk for breast and ovarian cancer. So let's move on to another really common question I know you get asked all the time is if I've had a hysterectomy and I don't have a uterus or cervix, do I even need to come in for a annual GYN exam?
Speaker 2:Oh, yes, that's very common too, yes. So the answer, short answer, would be yes, you do, because the annual exam does consist of both breast and pelvic and vaginal exams. So I do tell my patients just like flat out, like uncandid, like, even though you don't have a uterus, you still have a vagina. So be like that.
Speaker 2:And a vulva, yes, and a vulva, and you're still prone to get any of these items, you can still get any type of infection, like you still engage in intercourse and you may have some problems problems like gynecological issues and you want to be established with a provider and see them every year so that you can be up to date on your exam, so we know what's going on and then when you have a question or a problem does arise, we're not like scavengering and looking around for someone to see you right away. When you have someone and you've been seeing them yearly. So, yeah, it's very important. Like, um, we see people other, um, everyone, even if you don't have a uterus.
Speaker 1:Yeah, you're still a woman and checking muscle tone, rectal exams, maybe colorectal cancer screenings which, if you didn't listen to our uh march of 2024 podcast on colorectal cancer screening, we're seeing it skyrocket and we're starting to screen a lot younger women like 45 or even earlier and you can't see certain parts of your skin. Also, weight and blood pressure and lab results, medication refills A lot of people, I think, are busy, they don't want to have to come in and pay a copay and they just want to get their refills. A lot of people, I think, are busy, they don't want to have to come in and pay a copay and they just want to get their refills. So what's kind of your guidelines on how you handle when women call in for asking for refills for birth control pills or hormones or other medications?
Speaker 2:Well, yeah, a lot of the time, like, we understand that life gets in the way sometimes and things come up. So a lot of the time we'll offer like, for example, if someone needs a refill on their birth control or HRT, if they've been seen very close to about a year ago, we usually will pen the temporary refill to that patient. But we do ask that they schedule an appointment, have one on the books within about three months, because that's the longest like a refill will go, especially like a mail order pharmacy to get that fill in, just to have enough time and give you adequate time to schedule, and then when you go to your follow-up appointment you'll get the remainder of your refills.
Speaker 1:Yeah, that's very important, I know I certainly myself. As soon as I have that appointment, whether it's with the eye doctor or with women's health or primary care, I make the next year's appointment so that it's within that 365 day mark, because there's no guarantee that somebody will get the prescription. And I just think to be proactive. I mean it's great that you nurses help the patients out, but I know that if they don't come in for appointments then the prescriptions do get canceled. So that's a little bit of a cautionary tale, mm-hmm. So moving on to the women on hormone therapy, my field patients many times might remark well, I'm on the estrogen, the progesterone, and I love the estrogen, but I don't like how that progesterone sometimes makes me feel. So is it okay, nurse Marissa, if I just stop the progesterone?
Speaker 2:Oh no, absolutely not, Especially if you have a history of endometriosis or if you have a uterus, because we do not want any changes to that lining that can lead to we don't like to say the c-word, but we don't want anything to lead to any type of gynecological cancer. So if you feel like that progesterone just is not working for you and you just need to stop it, you need to stop the patch or the pill also estrogen patch or the estrogen pill also because you want to protect that uterus.
Speaker 1:Absolutely. That is such important advice, and I even have nurses and physicians who you think would be more up on. Of course health and medicine do that. So all patients we treat the same and we want to have that high level of care for, and that's why I think it's good to bring in all your medicines, not just say, oh, look in the chart, because there can be a lot of changes about how it's dispensed from the pharmacy, how the woman takes it. And to be very proactive, even also with supplements, is important too.
Speaker 1:And you've been listening to the Speaking of Women's Health podcast. I'm your host, the Executive Director of National Speaking of Women's Health, and with me is one of our absolute favorite nurses, nurse Marissa Walker, who is a registered nurse, does a lot of triage, does nurse visits, helps our entire team and we're talking about common common questions, our entire team. And we're talking about common common questions. And she says we don't like to have to say the C word, which is cancer, but we always have to rule that out if there's problems. And that gets us to the B word, bleeding, and I know that you and certainly I handle so many messages and calls about bleeding and women will tell us well. Well, I just missed my dose, or I was traveling, or my patch fell off and then I bled. So that's the reason, right. But what does that buy them, so to speak, in terms of your responses?
Speaker 2:oh, a lot of times. So we can't ever like rule out that there may be um anything wrong. We it can be anywhere from a fibroid to a polyp, some changes in your lining, once again too thick of a lining in the uterus. So we do want to just rule out any changes that we can nip in the bud right away that may cause the bleeding. And also just to piggyback off of that question. A lot of people will say, well, I had bleeding but it stopped, so I'm good, I'm good, I can just stay on my. I'm like no, no, no, no, no, no. We still recommend to either um schedule a follow-up exam or you may have imaging done anything like called an SIS, a pelvic ultrasound. Sis is like a saline-infused ultrasound where we look into that endometrial cavity and we see if there are any abnormal structures in the uterus or in that lining there and then from there we'll see what we have to do after that, like if anything needs to be removed or if it's healthy for you to continue the HRT or hormone replacement therapy.
Speaker 1:Or maybe needs to be dose adjusted for women who can't even tolerate natural progesterone, which is a small percent of women. Sometimes we use designer hormones like Duave, but we can't make hormone changes, especially in a woman over 40, if there's a possibility of cancer or infection or anatomical structural changes, and I know that's annoying to have to undergo it. I've certainly undergone ultrasounds and biopsies in the office and DNCs. It's just unfortunately sometimes part of being a woman and we have to woman up and you know and deal with it. And I know that a lot of our patients try to kind of beg you, nice nurses, oh, it's really okay, it's really okay and they just want your reassurance and most of the time it is okay. But we just can't do that because we've all seen examples and we don't want to miss things, regret it down the road. So I really appreciate you nurses being so understanding and educational, but pleasant and firm, and it's kind of like kind of how you have to be sometimes with your children, right, yeah, definitely, yes, yes.
Speaker 1:So moving on to the pap smear results, I know a lot of people are really anxious to get the results and they don't get them right away. It can take a week or two or more for your pap, and then sometimes people get the results of their blood work or their pap smear even before their doctor or nurse practitioner or physician assistant even has a chance to take a look at it, and so you get a lot of those, which really kind of slows your day down and makes extra work. So do you have any words of advice about patients taking a deep breath and waiting and not jumping on the gun too fast?
Speaker 2:Yes, I always just say there's nothing wrong until there's something wrong. So, yes, well, I'm even one of those people I'll get my results back and I'm like what is this? Oh my, and then you'll have. And then I'm like like I need to message my office, but it's saturday night, so you know, I still have to wait a moment. Um, I do say stay away from, like dr google, because they are not always reliable. Um, and it's it is frustrating to have to wait.
Speaker 2:Um, you should get response back. When you get results, especially especially abnormal results, back within at least two days. If it's urgent, you will get a call back very soon, very, very soon. If there's something critical, we actually get notified if there are critical labs. So in the event that something is super critical and an intervention needs to be done right away, we would be um jumping on that, like immediately we get a call. We have to respond within a like a certain amount of hours, and I mean like single digits, like I think it's like two or three hours. So we would definitely get on that. Um, otherwise, it can take about like a day or two for the physician or the nurse practitioner to get back to you with those results.
Speaker 1:Yeah, and a lot of times I know when I get the messages well, the patient wants to know what you think about a lab value that's just slightly outside of normal range. I haven't even looked at it yet because I'm seeing a full day of patients, right, because if it is a lab critical value that's life-threatening, then the lab calls us and we have to deal with it right away. So most of the time, thankfully, it's not that, and sometimes we just like to wait till we have all the results back to get the full picture to say this is what you need to do, and most of the time, if you're getting a comprehensive evaluation, you should already have a follow-up visit, either in person or virtually, to go over those results and not expect that the health team is going to just drop everything for just minor changes that are not emergency. The flip side of that is, though, I have some women who are real chill and real relaxed, and they're like I never heard anything, so I thought it was fine.
Speaker 1:I mean, everybody should always get reports of their PAPs, of their ultrasounds, of their blood work, and if you don't hear back, maybe you're in a healthcare system that you're listening, that doesn't have MyChart and that electronic documentation and communication. Maybe you're in a private practice or it's a send-out lab and I do think that as an individual patient you should have that responsibility to make sure that the ends are everything's wrapped up. So one common abnormality especially in women over 50, is getting a pap smear that shows atypical squamous cells of unknown significance, so-called ASCUS, and if the HPV, either direct or reflex, is negative, meaning you don't have the virus that's associated with pre-cancer or cancer of the cervix, it's just atypical cells without the virus. I know you get lots of questions about I want to get my pap smear again right away, or why do I need to wait a year?
Speaker 2:Yeah, because what people don't know is that those oscar cells cells they can be a direct like a result of vaginal dryness, menopausal hormonal changes, having intercourse, having any type of like infection, like maybe BV, which can resolve on its own from time to time. I'm a yeast infection if you do have any like STIs or STDs that can cause some atypical cells there. But a lot of time we don't like to just keep repeatedly going in unnecessarily billing you. We don't like to do things like be invasive when we do not have to. Like the ACOG guidelines do say it's safe to wait a year, follow up on a year with those, especially not with the HPV infection, because the HPV infection is what generally will cause that cervical cancer, not those atypical cells itself, because atypical can happen from almost anything. Almost a sneeze can give you the typical cells. Yes, it's very.
Speaker 1:It's very common. And for those women that are in the menopausal range, even if they're not feeling vaginal dryness or pain with sexual activity or bladder overactivity, I will always prescribe either vaginal estrogen or vaginal DHEA for at least two months straight before you come in for that repeat pap. There are some clinicians that will say, oh, you can wait three years. I think that's too long personally, just like I think five years is a little bit too long, and you know, people change jobs, they might move, they have different healthcare insurance. I just think it's too long a period of time. But our nurse practitioners are really good. They'll get you in within a year. But you have to take the responsibility as the patient and do that.
Speaker 1:Whatever that vaginal treatment is, and for those women with common minor vaginal irritations and conditions like bacterial vaginosis, bv, yeast infections we've had prior podcasts on that. You can go on speakingofwomenshealthcom and under the search button put BV podcast or just BV or vaginitis or vulvar care. Those are some of our most searched read information. The next question as we're starting to wrap up is can my women's health nurse practitioner, physician adjust my dose of hormones or oral contraceptives just on their own, without an appointment?
Speaker 2:Oh no, yeah, you definitely need an appointment because we have to get further evaluation from the nurse, practitioner and physician. So if you feel like you need an adjustment that tells us that something's wrong, like something's going wrong or you're still feeling some symptoms, we need to dig in deeper a little bit and see what's the cause of those symptoms. Like we have to check some lab work, we have to talk to you know what we need to order, we have to see what else is going on. Um, so it's really important to have, like, another visit on the books before we get any further blood work and then before we adjust any dosages, because you may not need an adjustment, you just may need a change in therapy altogether, but we won't know that until you see the doctor or the NP.
Speaker 1:Yes, and that kind of also goes along with people wanting new hormone regimens. I mean, maybe they have a new medical problem, Maybe their thyroid hasn't been checked, Maybe their blood pressure is too high for certain types of regimens there's so many different factors that can be taken into effect. I think the other question that comes through a lot is I think I have an infection it seems like the one I had before and I just want a prescription. I don't want to come in or I don't want to go to urgent care. Will you just give me the antibiotics now? I mean, I know you get those questions.
Speaker 2:Oh yeah, that one too, yes, and the reason why we can't just give an antibiotic again is because, well, it is an antibiotic and we don't want to treat you with the wrong treatment when it could be something else. Some of these like symptoms that one may have, like the itchiness or like the irritation. It could be an infection of yeast, it could be an infection of bacteria. We wouldn't know until after we test you. We want to ensure the proper treatment for your safety. Have any type of like top, like a tolerance to the antibiotic or resistance to the antibiotic they use because you're overusing it, thinking that you have, like this, recurrent bv?
Speaker 1:um, so, yeah, we always recommend coming for an appointment that really, that is really the best advice and what I tell women who have um, who've been evaluated and and and know in the past they've had bv or yeast infections or maybe bladder infections like after sexual activity assuming they've been previously evaluated and they're a stable patient and they know they're going to go on a cruise or they're going to be away, you can ask at the time of your annual visit whether you're getting a pap or not, because maybe you need one, maybe you don't. That's the time at the annual visit to say getting a pap or not, because maybe you need one, maybe you don't. That's the time at the annual visit to say can I have a prescription that I can just have on hand? Okay, but when you call in with new symptoms and new problems, we're obligated to do a new evaluation.
Speaker 1:And so I think that's a little bit of insight, information and that might be a way for women who truly have already been evaluated. But it's not fair for the triage nurse or the covering physician or covering nurse practitioner who doesn't have a relationship with the patient, to be just demanded that they get a prescription. And I know that that's an uncomfortable situation that sometimes that you're involved in. And the other issue is when women say I want to get an appointment right now, but they say I have to wait three months. What advice do you have for those women?
Speaker 2:So if the provider that you prefer to see is completely booked up or booked out, we have a team here. Yeah, we can refer you out to the other providers on our WHI team here that can see you and that can help treat you if you need anything and evaluate you and assess your symptoms.
Speaker 1:So you're saying that you might not get to see the person that you want to see, but if you're flexible and it's urgent, usually you can get an appointment, either in person there are some providers that have a little bit of a sooner availability than others still building up their patients and clientele here. Yes.
Speaker 2:Yeah, and they're completely confident, knowledgeable and they can treat, they're completely confident, knowledgeable and they can treat Well.
Speaker 1:Thank you so much, Marissa, and you are such a gem and I really appreciate you joining us on this Speaking of Women's Health podcast, and I want to thank our listeners for tuning in. We're so grateful for your support and we hope that you'll support our podcast, Share it with others, Forward it to your friends, Leave us a five-star rating. You can even donate on our speakingofwomenshealthcom site and to catch all the latest from us, make sure you subscribe. It's free, Just hit the follow button. Anywhere you listen to podcasts Apple Podcasts, Spotify tune in. That way, you won't miss any future episodes and we'll see you next time in the Sunflower House. Remember be strong, be healthy and be in charge.
