Menopause Isn’t a Moment—It’s a Journey

[00:00:00] Pete Waggoner (Host): Hi there and welcome to Beyond the Checkup, brought to you by Stellis Health, where Neighbors Care for Neighbors.

[00:00:00] Pete Waggoner (Host): Hi there and welcome to Beyond the Checkup, brought to you by Stellis Health, where Neighbors Care for Neighbors.

[00:00:05] Pete Waggoner (Host): I’m your host. Pete Wagner. Today we’re talking about menopause and perimenopause, what it is, what to expect, and how to feel your best through it all. Let’s dive right in. We have three providers here from Stellis Health. We’re really excited to have you three here. Lindsey Latteman Amanda Zehrer, and Danielle Schirm to the three of you.

[00:00:26] Pete Waggoner (Host): Good morning and I’m really looking forward to diving into this. So here comes the big softball question to start. How do we define menopause?

[00:00:38] Danielle Schirm, DO: So natural menopause is defined by 12 months that have passed since a final menstrual period.

[00:00:46] Pete Waggoner (Host): And there are things that can or can’t occur between that. Is that correct?

[00:00:50] Yeah. So in that menopausal transition, which is your perimenopause you have a variety of different symptoms that will. Beginning into, throughout this podcast. But it [00:01:00] includes irregular bleeding, can include progressively skipping menses, shorter menses until you finally get to that one year without any bleeding.

[00:01:08] So you won’t know that you’re menopausal until you’ve hit that final, month

[00:01:11] Pete Waggoner (Host): So is it really a rounded time where it’s like, okay. Calendar starts here.

[00:01:17] Lindsey Latteman, MD, FACOG: Yeah. I like to describe menopause as a tunnel, not a doorway because you have to go through those 12 months of not having a period before you, we can officially say that you’re in menopause, but before that, there’s this time where things are starting to ramp up.

[00:01:32] Lindsey Latteman, MD, FACOG: You’re starting to have irregular periods, things are changing. And so it’s a long. Timeline before we really draw the line.

[00:01:38] Pete Waggoner (Host): So I think the misconception is that it is the perimenopause stage that people call menopause.

[00:01:47] Pete Waggoner (Host): Is that correct?

[00:01:47] Danielle Schirm, DO: That’s correct, So many patients don’t. Distinguish perimenopause from menopause until we technically say post menopause. And they always wanna know where they’re at in that process, which [00:02:00] we don’t always have an answer for.

[00:02:01] Amanda Zehrer, MD: And I think a important point to say for these patients too, is when you very first start having symptoms to when you’re done having all those symptoms is roughly five to 10 years.

[00:02:09] Amanda Zehrer, MD: So it’s not even a short timeframe. It’s, it’s a pretty significant amount of that time.

[00:02:13] Pete Waggoner (Host): This could be up to a decade. Mm-hmm.

[00:02:15] Lindsey Latteman, MD, FACOG: Yeah. Wow. And so that’s why we like patients to know that it’s important to tell us about symptoms that they’re having because that’s a long time to be miserable. So I don’t want patients to be suffering and think that there’s nothing we can do about symptoms because there is a lot that we can do, and it’s a long time to be waiting for it to be over.

[00:02:32] Danielle Schirm, DO: There are also super flashers, as I like to call them, which are about the five to 10% that will flash for decades.

[00:02:39] Pete Waggoner (Host): Do you, do you have a percentage? For me?

[00:02:41] Danielle Schirm, DO: About 10%. Wow.

[00:02:42] Pete Waggoner (Host): Wow. Okay. That’s, that’s, that’s significant I think.

[00:02:46] Danielle Schirm, DO: Yes. Yes.

[00:02:47] Pete Waggoner (Host): Do you have people come in and, and maybe think their symptoms or things that they’re feeling are completely different from really this, I mean, do, do and sometimes do [00:03:00] you say, well, and what, what’s the level of belief they give you when you say that?

[00:03:04] Amanda Zehrer, MD: Well, I think in this transition too, part of it is natural aging. And so a lot of symptoms that people come in within the menopausal transition can just be a natural part of that. And so that sometimes that can be sleep disturbance, mood changes, weight gain. You know, hot flushes can also be a side effect of multiple medications that you may be started on.

[00:03:22] Amanda Zehrer, MD: You know, during those life transitions so like beta blockers as one antidepressants is one that can also mask as hot flashes. So it’s not always just menopause. We have to rule out some of those other conditions.

[00:03:33] Pete Waggoner (Host): Then next question for you is we’re talking about things they talk to you about.

[00:03:37] Pete Waggoner (Host): So what are some of those common symptoms that you run into?

[00:03:41] Lindsey Latteman, MD, FACOG: Yeah. The biggest ones I think that always get the most press are things like hot flushes and sometimes even cold flushes, sleep disturbances, like trouble with sleeping, waking up and not being able to fall asleep again, night sweats, waking up, drenched in sweat.

[00:03:55] Lindsey Latteman, MD, FACOG: Memory problems or brain fog is how people often describe it. Feeling like [00:04:00] they’re searching for words and can’t quite pick them out. Lots of irritability, sudden episodes of rage. You know, things that their children or their husbands do that suddenly are driving them crazy that.

[00:04:11] Lindsey Latteman, MD, FACOG: They used to tolerate. Okay. I think those are the ones that most patients will usually describe it, at

[00:04:16] Amanda Zehrer, MD: least to some extent. And in my practice I lot of, I see a lot of the incontinence and pelvic floor problems that also come up with this. Because you can get what’s called genital urinary syndrome of menopause, where that really, exacerbates those symptoms that may have been mild when you were younger.

[00:04:30] Amanda Zehrer, MD: And now in this transition, really flare up.

[00:04:32] Pete Waggoner (Host): Do you think sometimes people say, what’s wrong with me? You know, and they don’t realize that this is kind of

[00:04:37] Danielle Schirm, DO: natural

[00:04:38] Pete Waggoner (Host): ca Yeah. How do you handle that? Mm-hmm.

[00:04:41] Danielle Schirm, DO: We talked to them about how this is the natural progression as you age, but it’s also not something that you have to quote to deal with.

[00:04:49] Danielle Schirm, DO: I think historically there could have been this push of, well, this is just life of a woman, you know, boohoo. Deal with it. [00:05:00] Yeah. And we’re really trying to progress women’s health towards educating women that there are lots of things that we can do to help this process lessen the symptoms for them.

[00:05:10] Pete Waggoner (Host): Do you find that generally there’s, I mean, it’s hard to generalize, but there’s an age where you can start queuing in on this as a whole.

[00:05:20] Lindsey Latteman, MD, FACOG: I would say in your early forties is when most patients start to kind of have a few symptoms. And I see a lot of patients that are 43, 44, sometimes even earlier than that too.

[00:05:30] Lindsey Latteman, MD, FACOG: And starting to have a few of the hot flashes or other symptoms that they’re starting to read about online and think, you know, maybe this is perimenopause. And when they come in and describe their symptoms, usually it’s like a, a who’s who of the top most common symptoms. And I say, yep, that sounds like it to me.

[00:05:45] Pete Waggoner (Host): You did mention online.

[00:05:46] Lindsey Latteman, MD, FACOG: Yeah.

[00:05:47] Pete Waggoner (Host): How accurate is that info out there?

[00:05:51] There’s variable. Right?

[00:05:52] Pete Waggoner (Host): Right. I mean, I mean, but like, how do you know? What would you suggest to that? Yeah. I’d

[00:05:56] say there’s a lot of misinformation just because women’s health historically hasn’t [00:06:00] had the same amount of research as other fields of medicine, and so there’s a lot of people that are trying to sell supplements and quick action things, and things that actually are really kind of dangerous in terms of bioidenticals and herbal supplements and those types of things.

[00:06:15] So it’s important to get the right information from an OB GYN provider.

[00:06:19] Pete Waggoner (Host): Fair enough. Okay. And then you, we started talking about what people are looking for for treatment options inside your practice. What does that look like? I mean, this is a long list of symptoms. Mm-hmm. And I, I don’t know, is it possible to treat most of these and what do you typically do in this case as far as treatment options?

[00:06:37] Pete Waggoner (Host): Yeah.

[00:06:37] Lindsey Latteman, MD, FACOG: For a lot of patients, if they’re healthy or don’t have a lot of other complicated medical problems, estrogen is the. Leading reason that they’re having all these symptoms. So not having enough estrogen is what causes the symptoms of menopause. And so estrogen is often the answer.

[00:06:51] Lindsey Latteman, MD, FACOG: Now, there are considerations for that in terms of patient’s cardiovascular health and also their family history of things like breast cancer or ovarian cancer. And so [00:07:00] sometimes we take that into consideration and there’s alternatives to that. But estrogen often is the, the load stone for that. The downside to that is that you also need progesterone if you still have a uterus because.

[00:07:10] Lindsey Latteman, MD, FACOG: While estrogen fixes all of the symptoms, it also can make things like the lining of the uterus grow willy-nilly. And the more that it does that, the more it puts you at risk for problems with uterine cancer or uterine pre-cancer. And so progesterone helps kind of fix that end of things. So you kind of need both components if you still have a uterus.

[00:07:28] Amanda Zehrer, MD: And for patients, if they have any contraindications to estrogen, there are some other options available for mostly what we call those vasomotor symptoms of those hot flushes. So there’s a newer medication called ve oza, which targets the heat sensor of your brain, and then there’s some, what we call off-label uses of certain antidepressants or gabapentin, which can also help particularly with those nighttime hot flashes or night sweats.

[00:07:49] Pete Waggoner (Host): For the things that are affecting your mind, where you’re feeling the fogs, you’re like, oh no, am I getting dementia here? How do you deal with that?

[00:07:57] Danielle Schirm, DO: Yeah, that’s hard because we haven’t found [00:08:00] studies to be supportive of estrogen helping the brain fog. Mm-hmm. Or preventing dementia, which is a bummer.

[00:08:08] Danielle Schirm, DO: Yeah. Mm-hmm. I do always tell my women that this brain fog. Period of life does generally improve with time. You know, unless there’s something else going on or something else as the cause. And so if they feel very fuzzy brained, misplacing their keys, you know, as they go through this transition, it does tend to get better with time.

[00:08:29] Pete Waggoner (Host): What would you say while you’re going through this process, and there are all these changes that are occurring for loved ones, whether it be partners or kids or whatever it may be. What’s the best type of support they can provide and how?

[00:08:42] Lindsey Latteman, MD, FACOG: Part of it is being understanding and knowing that anytime anybody’s going through a life transition, it makes things really hard.

[00:08:49] Lindsey Latteman, MD, FACOG: You think about teenagers going through puberty, that’s a time of a lot of emotional instability and reactivity, and it’s kind of similar for people going through menopause. So maybe giving [00:09:00] your loved one a little bit of grace and sort of stepping back and realizing that some of this is. Maybe things that you’re doing to bother them, but maybe some of it is just that that’s how they’re reacting in the moment.

[00:09:09] Lindsey Latteman, MD, FACOG: They need a little extra help to be kind to themselves.

[00:09:12] Pete Waggoner (Host): I think it’s very important for people that don’t know what that’s about, to understand that and to step back and provide the grace you suggested to understand things are different, and knowing that there’s depth to it and it’s not just a thing.

[00:09:27] Danielle Schirm, DO: And also to support them to come see their provider too, because there are lots of options to help with the mood piece. And, and sometimes it’s about sleeping better. If they’re waking up a lot at night to go to the bathroom, then estrogen can be really helpful. Either vaginal, estrogen or even.

[00:09:43] Danielle Schirm, DO: Systemic estrogen. And the progesterone’s been shown to help with sleep as well. And so, there’s lots of things that we can do to help them sleep better, which can improve the mood during the day.

[00:09:53] Pete Waggoner (Host): Isn’t it crazy how that works? Biodentical hormones does that play into the [00:10:00] estrogen or is that different?

[00:10:01] Lindsey Latteman, MD, FACOG: Yeah, there’s a lot of marketing around the idea of bioidentical hormones, so versus. Hormones that are synthetic or created by pharmaceutical companies. And part of that is that I think everyone wants the most natural approach to their life that they can, right? I think most people would avoid medications if they can help it.

[00:10:19] Lindsey Latteman, MD, FACOG: And so the marketing around bioidentical hormones kind of focuses on saying these are some kind of specifically compounded medication that’s made just for you that’s gonna match what your body does. There are already bioidentical formulations that are actually approved by the FDA and manufactured successfully on mass that we know can be prescribed safely.

[00:10:41] Lindsey Latteman, MD, FACOG: The problem is when people are being prescribed a lot of bioidentical quote unquote hormones, but they’re compounded at a compounding pharmacy where there’s just this not the same level of safety qualifications and safety checks to make sure that the dosing is consistent or that the the quality of the product is consistent [00:11:00] across the entire tube of medication.

[00:11:01] Amanda Zehrer, MD: I think even knowing that you’re getting what it says you’re getting, ’cause you can get a lot of contamination in those products as well. And I think an important part is also to say, it’s not like it’s some lady doing a mortar and pestle and doing something real natural, putting yams in there.

[00:11:14] Amanda Zehrer, MD: It’s still synthetically made. So when people think they’re getting a natural product, it’s, you know, it’s just a, a worse version of what you get as a prescription.

[00:11:23] Danielle Schirm, DO: I was just gonna add that as an example. Estradiol is bioidentical, so it’s considered that, but people will not accept it or the prescription at times and get it elsewhere because something else is marketed.

[00:11:38] Danielle Schirm, DO: And has that stamp or label on it that makes them feel like that is more natural than the prescription option? Of course. ’cause they

[00:11:45] Pete Waggoner (Host): say it’s natural. Yes. Right? Yes. And you’re saying it’s not really made natural? Correct. Okay. Do you go through some sort of testing process for this? How do you determine if you, if you go there.

[00:11:55] Lindsey Latteman, MD, FACOG: Yeah. Yeah, I think that’s a great question and something that we get from patients all the time. They want to know if [00:12:00] there’s a lab test we can do to just know, or am I in menopause? And the thing that’s so tricky about the endocrine system in general and women’s hormones in particular, is that they fluctuate widely throughout the day.

[00:12:11] Lindsey Latteman, MD, FACOG: And then from day to day. And so the levels of the hormones that we would potentially test if we were, if we were unsure. Sometimes there’s some scenarios that are hard to delineate. If we’re not sure, some of those hormones can go really high one day and make it look like you’re in menopause. And then the very next day they might be back in the normal reproductive range.

[00:12:28] Lindsey Latteman, MD, FACOG: And if we, even if we test a couple times, we. Inadvertently get two results that are high when you’re still in the sort of perimenopausal or premenopausal range most of the time. And so it’s, it’s just not very consistent and it doesn’t help us to take good care of the patient. So I always tell patients that it doesn’t tell me what your symptoms are, and it doesn’t tell me how you’re gonna react to the medication.

[00:12:50] Lindsey Latteman, MD, FACOG: And so we, we treat based on symptom. Got it.

[00:12:52] Amanda Zehrer, MD: And I think a risk of that too is that you can miss that episodes of Breakthrough Ovulation and where you can still get pregnant. So someone may be [00:13:00] falsely told they’re menopausal and they think they can’t get pregnant, and then that’s when we have those late in life pregnancies that happen.

[00:13:07] Amanda Zehrer, MD: So it’s important to be protected all the way through that transition as well. And another point I was gonna say on that is we also don’t. Titrate your medications based on any sort of lab values. If someone’s doing that, they’re not doing the right thing by you. We should really be just changing it based on your symptoms.

[00:13:22] Lindsey Latteman, MD, FACOG: You could have two people that have the same estradiol level on a lab test, but they may have vastly different symptoms. And so it’s not helpful to guide what dose of estrogen you should be on or what type of medication or how often you need to dose it or whatever the, variables may be. It doesn’t tell us anything.

[00:13:38] Danielle Schirm, DO: There is a time that we do recommend getting something called a follicle stimulating hormone test or an estradiol level, and both often would be if someone’s less than 40 and they’re having a lack of a period. Then they will get some of those hormone tests, check a thyroid, in order to diagnose something called POI or premature ovarian insufficiency.

[00:13:59] Danielle Schirm, DO: And [00:14:00] that’s important to be diagnosed with officially because there are health implications to having no estrogen at a very early age.

[00:14:08] Pete Waggoner (Host): We scratched on this, a little bit. From a patient perspective, what do you think some of their preconceived or misconceptions would be about all of this?

[00:14:20] Lindsey Latteman, MD, FACOG: One of the big things is that I think that people are afraid of hormones, but they also know that kind of the general sense is that hormones are the answer. And so I think there’s a lot of conflict within patients that come to see us sometimes because they know that they want relief from their symptoms, but they’re a little bit afraid of the idea of hormones.

[00:14:38] Lindsey Latteman, MD, FACOG: And so sometimes that I think is. A kind of a big barrier to go over and to, address.

[00:14:44] Amanda Zehrer, MD: I would also say one misconception is that also that if you start hormone treatment, it will be the end all, be all fountain of youth and everything will go back to when you were in your twenties.

[00:14:53] Amanda Zehrer, MD: And part of it is just knowing what is also just going to be a natural part of aging. Mm-hmm. And, and adjusting to that new lifestyle and [00:15:00] also lifestyle changes that should occur during this transition for both heart health, osteoporosis, the other things that can go along with with this transition.

[00:15:08] Pete Waggoner (Host): How many people that are aging do you sense could kind of settle into a little denial, and do you see if there’s a difference between acceptance and denial with aging better?

[00:15:23] Amanda Zehrer, MD: I actually found culturally, like especially in Asian cultures, where aging is a natural thing, uhhuh and is seen as a healthy part of life, that they tend to have less negative symptoms around the menopausal transition than interesting than in the United States where it is seen very negatively and where your value is tied more to your reproductive potential.

[00:15:39] Amanda Zehrer, MD: So culturally we do see a little bit of that.

[00:15:42] Pete Waggoner (Host): I was speaking with a friend from Spain today and I told him what I was doing and. He’s about my age, fifties. And he said, what’s that? I thought that was fascinating. So a gentleman in Spain had never even heard of it. I thought that was [00:16:00] like wild.

[00:16:01] Pete Waggoner (Host): So I wanted to dig into that a little bit more, but we had to go. But that kind of supported what you were suggesting? Mm-hmm. Yeah. How about as, as far as menopause itself or perimenopause? Misconceptions that. People may have about it that come to see you, like they come in with a preset mind of like, this happened with my mother and then this is me.

[00:16:26] Pete Waggoner (Host): Do you run into that type of thing?

[00:16:28] Danielle Schirm, DO: One example I think of right away is a woman coming in saying that there’ve been told by their friends that their vagina will close up

[00:16:35] Pete Waggoner (Host): serious. There’s

[00:16:36] Danielle Schirm, DO: Yes. And there’s thinning of the vaginal tissue mm-hmm. And changes that also occur in the, the urinary system.

[00:16:44] Danielle Schirm, DO: Mm-hmm. The bladder that are associated as well that do occur and, and that thinning tissue can cause pain with intercourse and, and just changes in the vagina and the vulva. But closure is not, not a thing.

[00:16:58] Lindsey Latteman, MD, FACOG: That almost makes me think of. [00:17:00] Maybe patients who’ve had friends who’ve had other like skin conditions of the vulva, which are very, very common in women in perimenopause and menopause.

[00:17:08] Lindsey Latteman, MD, FACOG: There’s some specific kinds that can cause some scarring of the outside, but menopause itself doesn’t cause that. And so that’s why it’s important to still see your OB GYN or your women’s health provider because. There are other things that we should be looking for that might be more common in menopause, but aren’t caused by menopause itself.

[00:17:25] Danielle Schirm, DO: To that point, it’s important to continue to have a pelvic exam, even if you’re told you no longer need a pap smear because the pap smear is solely for screening of cervical cancer. Mm-hmm. And routine guidelines. If you’ve had normal pap smears over the years, never had a history of dysplasia that you can.

[00:17:45] Danielle Schirm, DO: Consider discontinuing testing at 65. And so some women will continue to not have a pelvic exam for years and then come in with something really significant of the vulva or vaginal tissue because they haven’t had a provider do an exam [00:18:00] in so many years. Yeah,

[00:18:01] Pete Waggoner (Host): largely ignored.

[00:18:03] Danielle Schirm, DO: Yes. Mm-hmm.

[00:18:04] Pete Waggoner (Host): As far as conversations with this, how do you set people at ease saying.

[00:18:11] Pete Waggoner (Host): This is okay. What does your typical conversation look like?

[00:18:15] Lindsey Latteman, MD, FACOG: I think just starting by saying everything you’ve described to me is completely normal and very common, and then explaining that all of them tie together. I think sometimes patients come in and say, I don’t understand what’s going on, because they have so many.

[00:18:28] Lindsey Latteman, MD, FACOG: Varied symptoms and then when you can say all of this fits with perimenopause or menopause sometimes I think it’s really reassuring to patients to know that there is sort of a single answer for everything that’s going on. And starting with that and then transitioning into there are things we can do to help depending on what’s going on.

[00:18:44] Lindsey Latteman, MD, FACOG: So,

[00:18:44] Danielle Schirm, DO: mm-hmm. I start a visit when someone comes in with a complaint that could be. Perimenopause or a, a menopause symptom. I, I put a list in front of ’em of my 15 plus things that can be [00:19:00] associated. We go through it, we check the boxes of are you experiencing this or are you not? So we get a good overview of all the things that are going on and then the choose the best treatment option for them based on what they’re experiencing.

[00:19:13] Pete Waggoner (Host): Re regarding that. How random is it? Do you see like. Two or three are always kind of bunched together. Of those 15, or can it be all over the map?

[00:19:24] I’d say the most common ones I see is the, the vasomotor systemness or the hot flashes, the weight changes and the brain fog. For me, I think it’s the three most common ones that you see.

[00:19:33] Yeah, the weight gain,

[00:19:34] Danielle Schirm, DO: right.

[00:19:34] Midriff, weight gain.

[00:19:35] Lindsey Latteman, MD, FACOG: Yeah. I feel like I get a lot of irritability and like mood changes. Sometimes from patients, I, it almost inevitably happens that I think almost every patient I talk to about this says, well, my husband would say I’m really irritable. And I always joke that, you know, I’m not asking him, I’m asking right on.

[00:19:51] Lindsey Latteman, MD, FACOG: Right on. So, you know, but I think that is just a common sentiment that they feel like there fuse is shorter. Yes.

[00:19:58] Amanda Zehrer, MD: I would say the menstrual irregularities [00:20:00] too are one that we see quite a bit. You can actually have. Initially heavier bleeding, which can be quite bothersome for patients. And so there’s different treatment options for that as well.

[00:20:09] Amanda Zehrer, MD: So it’s not just the spacing out and the lack of the menses, but in the very beginning worsening menstrual cycles

[00:20:14] Pete Waggoner (Host): so it can kind of fluctuate.

[00:20:16] Pete Waggoner (Host): And I suppose that could kind of , cause you to not, I don’t wanna say panic, but say, whoa, what’s happening here? Is this, I need to worry. Yeah.

[00:20:23] Lindsey Latteman, MD, FACOG: And in fact, yeah, that’s sometimes the first.

[00:20:25] Lindsey Latteman, MD, FACOG: Thing that people are starting to say in their early forties is their periods are getting closer together and much more intense. Sometimes the number of days is shorter in terms of like maybe three days instead of five days. But yeah. Those days are quite heavy in bleeding and so that’s something that’s really distressing for patients.

[00:20:41] Pete Waggoner (Host): How about lifestyle changes? Is there anything you can do physically and actively to impact this in a positive way?

[00:20:49] Danielle Schirm, DO: Yeah. Exercise and. Diet has been shown to have some benefit, even for vasomotor symptoms and, and just general health, mental health keeping [00:21:00] a, A-A-B-M-I that’s healthy.

[00:21:03] Danielle Schirm, DO: The exercise in diet piece is important for those.

[00:21:07] Amanda Zehrer, MD: I’d say specifically on that end too just for heart health, we recommend 150 minutes of aerobic activity a week at a minimum. Mm-hmm. And then in terms of your bone health osteoporosis in that menopausal transition, two of those days should be weight bearing.

[00:21:21] Amanda Zehrer, MD: So that could be weightlifting, that could be any activity that puts more weight onto the bones. And so that can help. With that transition, it also helps your cholesterol, so reducing your risk of heart attack and stroke in the future. And then in terms of diet, it’s the things we all know we should be doing and maybe not necessarily doing.

[00:21:36] Amanda Zehrer, MD: So more whole grains, fruits, vegetables, less processed foods, more poultry instead of red meats, reducing your alcohol. So all of that ties in with general health as well as improving menopausal symptoms.

[00:21:48] Danielle Schirm, DO: I tell people, a nine inch plate, instead of a 11 or 12 inch plate for portion control.

[00:21:54] Danielle Schirm, DO: Nice. A colorful plate focused on veggies and, and fruits.

[00:21:59] Pete Waggoner (Host): I [00:22:00] like that. Colorful plate. Yeah. Yeah. That’s really good.

[00:22:02] Lindsey Latteman, MD, FACOG: Yeah. Let’s be with our eyes. So that makes it more appealing. If your plate is, has a variety of colors on it, it’s both good for your health and good for your appetite.

[00:22:11] Danielle Schirm, DO: Yeah, completely. And to further emphasize the, the muscle building part, I think a lot of people struggle with body composition because of what they see on social media, what they used to look like.

[00:22:20] Danielle Schirm, DO: And so the gaining of the weight in the midriff is challenging to see in the mirror. And it, I tell ’em, it’s more about how you feel than what’s on the scale. And if you’re doing weight bearing exercise, then the body composition can change in a positive way that feels really uplifting. Women,

[00:22:36] Pete Waggoner (Host): it really impacts all those things you spoke about.

[00:22:38] Pete Waggoner (Host): Mm-hmm. By doing all of that, how about resources that are available beyond the three of you? Is there anything else they can, can get to, to learn more? Yeah,

[00:22:48] Lindsey Latteman, MD, FACOG: I would definitely recommend the Menopause Society. That is kind of the leading professional society for people who see patients in menopause and for guidelines.

[00:22:57] Lindsey Latteman, MD, FACOG: But they also have patient information on their [00:23:00] website as well that’s focused on educating patients. Using that as a guideline too. Not everyone who is well versed in menopause is a menopause certified practitioner, but that is also a, a certification you can look for. And so that is one way to kind of, to kind of vet the recommendations is to kind of compare what the Menopause society is recommending versus like what someone is to telling you you might need.

[00:23:21] Amanda Zehrer, MD: And I’d say on the opposite end, people to avoid is anyone that’s trying to sell you a product. So your provider that you’re seeing for information shouldn’t be directly selling you. A supplement or any sort of, yeah, thing like that. They shouldn’t be profiting from that information that they’re giving you.

[00:23:36] Amanda Zehrer, MD: And then

[00:23:37] Lindsey Latteman, MD, FACOG: anyone with who’s recommending routine labs every month or every couple of months to test their levels in order to fine tune or adjusting your medications is probably doing that more as a cash grab it. I hate to say that because I don’t want to throw anyone under the bus,

[00:23:51] if anyone offers you spit testing, just walk right out the door. Yeah. Which is

[00:23:55] Pete Waggoner (Host): great. If you could see the room is like, like, like kind of cheering. We get some jazz. [00:24:00] We had some jazz hands going here, the whole thing. It was great. No, that, that was good.

[00:24:05] Pete Waggoner (Host): So, we’ll wrap up with each one of you sharing what you wish people would understand more about perimenopause and menopause.

[00:24:14] Danielle Schirm, DO: I want women to know that they can come in and we will help them. I want them to feel supported that it’s, not a, one time visit. Sometimes it takes them adjusting.

[00:24:25] Danielle Schirm, DO: But I want them to feel encouraged and motivated to come in and ask for help rather than feeling like it’s, just a step you know, in aging, but something that we can empower them to, feel good during the process. And that there’s a lot of positive aspects to. To life in this transition.

[00:24:46] Amanda Zehrer, MD: I think to add to your point, I would also encourage women to talk to their friends and families about it because we were trying to normalize this transition and make it more of the discussion and increase, you know, awareness for everybody.

[00:24:57] Amanda Zehrer, MD: So I think to remove the stigma and. [00:25:00] Be, dealing with these symptoms in private is not the way to go. I think it’s to chat and see what other people are trying and talk to your doctor about, oh, my friend tried this. Do you think that would be helpful for me? These are the symptoms I’m having.

[00:25:10] Amanda Zehrer, MD: So just reiterating, chatting with everybody and then coming in and seeing what we can do for you.

[00:25:14] Lindsey Latteman, MD, FACOG: Yeah, and I think just being willing to talk to us about those symptoms is the first step. And then being willing to think about what are all the options we have to treat the symptoms, because sometimes.

[00:25:25] Lindsey Latteman, MD, FACOG: Hormones aren’t the answer for every patient. And so sometimes other medications are better depending on what symptoms are bothering you the most. I think when we were talking about some of the alternative things like antidepressants, it’s not ’cause we think you’re crazy necessarily. Mm-hmm. But because they work on the nerves and the nervous system and so sometimes that still is a good option for patients who don’t want to take estrogen,

[00:25:41] Lindsey Latteman, MD, FACOG: so I think just being open to the conversation and coming in to tell us what their concerns are so we can help.

[00:25:47] Pete Waggoner (Host): Well, what’s been great about this is we’ve covered so many. Aspects of this and so many different angles that I think if you really listen to this 30 minutes or so you’ll be a lot more educated

[00:25:59] Pete Waggoner (Host): [00:26:00] it’s okay. And what you need to do. And I think anybody that comes to the three of you are in good hands. And for me, this has been incredibly educating. But to the three of you, thank you so much. Appreciate you taking your time out. You’ve been great to work with and I, I would encourage everybody to come see you

[00:26:15] Pete Waggoner (Host): well, that’s gonna do it for today’s episode of Beyond the Checkup from Stellis Health. We’re neighbors. Care for neighbors. Thanks for listening. And remember, we’re here to help you stay healthy. Talk to your Stellis health provider anytime you need care.

[00:26:27] Pete Waggoner (Host): And don’t forget to follow beyond the checkup and share this episode with your friends and family. Thanks for listening and see you all next time.