Latest / MIT - Conversations with MIT Health / Piecing Together Perimenopause | Interview with Dr. Adi Ratner Nevo

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Piecing Together Perimenopause | Interview with Dr. Adi Ratner Nevo · MIT - Conversations with MIT Health

• 0:02
  Emily Wade (Host): A while back, we asked our listeners here at Office
• 0:05
  Hours to send us that health question that you've been googling at 2:00 AM.
• 0:10
  It's no surprise our MIT night owls sent us back some very specific
• 0:14
  replies, but among them was this extremely relatable question.
• 0:20
  "Dear Office Hours, if I'm googling at 2:00 AM, I'm asking
• 0:24
  about perimenopause symptoms.
• 0:26
  Am I on enough estrogen?
• 0:28
  Is my hair shed normal, or is it problematic?
• 0:32
  And how on earth did my mother survive her 40s and 50s?
• 0:35
  You know, normal stuff."
• 0:38
  So, on today's episode, we have Dr.
• 0:41
  Adi Rattner Nevo from MIT Health Primary Care to help us unravel the
• 0:47
  mysteries of the internet's current favorite women's health topic.
• 0:52
  Welcome, Adi.
• 0:54
  Adi Rattner Nevo, MD: Thanks so much, Emily.
• 0:55
  So happy to be here.
• 0:57
  Host: I'm so happy that you are here because you had a
• 1:03
  presentation at our town hall recently where you actually specifically
• 1:07
  talked about how people are asking a lot of perimenopause questions.
• 1:11
  So, this is very exciting to have you here to talk about this hot topic.
• 1:18
  And definitely while I am not, you know, up at 2:00 AM googling perimenopause,
• 1:24
  at some point, my Instagram algorithm definitely decided I'm in hormonal peril.
• 1:30
  So, you know, I'm going to get a lot out of this too.
• 1:34
  The question we have today is really interesting because there's two
• 1:38
  things about it that are really important, where it's like, you
• 1:42
  know, how did my mother survive her 40s and 50s is a very relatable and
• 1:48
  emotionally accurate medical question.
• 1:50
  But also, I think, a really key thing about this question is how are you
• 1:57
  supposed to find kind of like trustworthy and reliable information when the
• 2:02
  internet is, like, eager to give you 700 answers to every question, and many of
• 2:09
  those answers are advertising a product or service or patch or cream that's
• 2:15
  supposed to solve all of your problems?
• 2:17
  So, to get started there, let's just get to the basics.
• 2:23
  What is perimenopause?
• 2:26
  Adi Rattner Nevo, MD: Thanks, Emily.
• 2:26
  These questions are very relevant.
• 2:28
  So, perimenopause is the transition leading up to menopause.
• 2:33
  During this time, the ovaries start producing hormones less consistently,
• 2:37
  especially estrogen and progesterone, and the fluctuations in hormone
• 2:42
  levels could be pretty significant.
• 2:44
  This can lead to a range of symptoms.
• 2:46
  Menopause is officially defined as 12 months without having a menstrual
• 2:51
  period, but perimenopause is the transition before that point that can
• 2:55
  last for several years for some people.
• 2:59
  Host: So, it's kind of less of a moment, like a specific moment
• 3:03
  in time, and more of a phase.
• 3:05
  So, it's kind of funny that peri- is doing a lot in perimenopause.
• 3:10
  It's like it's shruggie pause really.
• 3:15
  Adi Rattner Nevo, MD: Exactly.
• 3:16
  It is a gradual transition, usually not an overnight change.
• 3:20
  Host: That's true.
• 3:21
  But I feel like sometimes emotionally, it can feel like you could go have
• 3:27
  a, you know, normal life and then, all of a sudden, you wake up in the
• 3:30
  middle of the night and you're like, "My mattress is like Death Valley,
• 3:35
  and I'm like covered in sweat.
• 3:37
  And what's happening to me?"
• 3:40
  So, it's like it does seem like there are pieces that can
• 3:44
  kind of come out of nowhere.
• 3:47
  Is that normal?
• 3:48
  Is that the case?
• 3:50
  Adi Rattner Nevo, MD: So, that can be the experience of many people.
• 3:53
  You know, and the thing that I talk about with patients is that people, your
• 3:57
  friends can experience it very differently from you, but there are some common
• 4:02
  symptoms that this can include starting to see changes in menstrual cycle, hot
• 4:07
  flashes, night sweats you're referring to.
• 4:09
  Otherwise, trouble sleeping, mood changes, brain fog, vaginal dryness,
• 4:15
  changes in libido or sex drive, headaches, joint aches, changes in
• 4:19
  hair or skin, and there are more.
• 4:23
  But the most important thing to remember is that sometimes these
• 4:26
  symptoms can represent other processes or medical conditions, but
• 4:31
  they can happen in perimenopause.
• 4:34
  Host: But if you're in, you know, your 40s, and these symptoms are
• 4:38
  starting to come along, s it a good guess to assume it's perimenopause?
• 4:45
  Adi Rattner Nevo, MD: It's a reasonable possibility, but not
• 4:47
  always the answer that these symptoms are solely from perimenopause.
• 4:51
  So, a lot of these symptoms, you know, can come from the hormonal
• 4:54
  changes, but also can show up in other conditions like thyroid disorder,
• 4:59
  anemia, depression, sleep apnea, side effects of medications that people may
• 5:04
  be on, pregnancy, and chronic stress.
• 5:09
  So, you know, I know a lot of people go online and try to find answers,
• 5:14
  which is totally understandable.
• 5:16
  And, you know, especially with AI now being a resource,
• 5:20
  that's quite widely available.
• 5:22
  But sometimes the self-diagnosis can lead us to anchor in on, you
• 5:27
  know, certain causes of things and can get people into trouble.
• 5:30
  I think that if anyone is questioning whether these symptoms may be from
• 5:34
  perimenopause, it could be that in the end that's what is causing it.
• 5:38
  But it's really important, you know, to come and see your
• 5:42
  provider and work through some of those questions and concerns.
• 5:46
  Host: Great answer for that.
• 5:48
  And I think you really touched on something, especially with AI.
• 5:53
  But also, it's just the general internet.
• 5:57
  It's like perimenopause content is having a moment.
• 6:02
  It is like the thing right now, at least.
• 6:05
  You know, judging from my Instagram feed, for sure.
• 6:10
  And I mean, on one hand, that's awesome because, you know, I think back to
• 6:16
  our listener talked about her mother and grandmother surviving this, and
• 6:21
  I'm thinking, like, my grandmother called this the change of life.
• 6:25
  So, you know, it's great that we actually have words to describe this.
• 6:29
  And we have like a language and a vocabulary to talk about it.
• 6:33
  But it does also seem like, you know, there is this way where it's like, you
• 6:39
  know, if I'm over 35 and I woke up in the morning and I can't find my keys,
• 6:45
  suddenly, you know, the internet is ready to tell me that my hormones have just
• 6:51
  given up and they've left the building.
• 6:53
  So, it does seem like a double-edged sword a little bit.
• 6:57
  Adi Rattner Nevo, MD: Absolutely.
• 6:57
  And, you know, social media can be a really great tool for raising awareness
• 7:02
  and making people feel less alone and finding community, but it does
• 7:06
  tend to oversimplify in particular in the area of medical education.
• 7:12
  Host: Yeah.
• 7:13
  You know, I think I've definitely seen a lot of stuff that's
• 7:18
  like, "This symptom means…"
• 7:20
  or, "Doctors won't tell you this, but…"
• 7:22
  you know,
• 7:25
  those are definitely, like, running themes that are kind of all over social
• 7:30
  media and the internet right now.
• 7:32
  Adi Rattner Nevo, MD: Absolutely.
• 7:33
  And I think when I talk to my patients, that's where I think
• 7:37
  people should be a bit skeptical or I caution people because, you know,
• 7:43
  rarely is there like one explanation.
• 7:46
  and when things tend to really simplify a concept into like
• 7:52
  one answer, I'm pretty wary.
• 7:56
  Host: I think it's a good time to help some people out, you know?
• 7:59
  And I think I definitely keep holding this guy up because, in researching t
• 8:05
  this, interview, my phone is like, "You have entered your crone years, and I'm
• 8:12
  only going to show you this content."
• 8:14
  so, let's talk about, you know, if somebody is googling symptoms
• 8:19
  or getting bombarded with this content, what are some good ways to
• 8:25
  tell that it's actually reliable?
• 8:28
  Adi Rattner Nevo, MD: So, some things to keep in mind,
• 8:31
  some of these things may help.
• 8:32
  First is who or what is the source?
• 8:36
  So, is this a licensed clinician, medical provider, or reputable
• 8:42
  medical organization, or sometimes, you know, academic center?
• 8:46
  Or is it somebody with a compelling personal story, and are they providing
• 8:52
  a discount code or any products that there's, like, brands that
• 8:56
  they're specifically promoting?
• 8:58
  The second thing is—and this might be a little vague at
• 9:01
  first—but how do they sound?
• 9:03
  Typically reliable sources acknowledge that there is nuance
• 9:07
  in many conditions or, you know, life phases like perimenopause.
• 9:12
  So if someone's making sweeping statements or absolute statements
• 9:16
  like, "This always means…"
• 9:18
  or, you know, "No one has ever…"
• 9:20
  or, you know, "Doctors are ignoring or not listening to you always,"
• 9:24
  you know, that's a red flag.
• 9:26
  You know, I do want to acknowledge that many individuals have experienced real,
• 9:30
  like, disenfranchisement or reasons to have mistrust in healthcare, but
• 9:34
  I would be cautious of just absolute statements, and black-and-white thinking.
• 9:40
  And the third thing is, are they trying to sell you something?
• 9:44
  This doesn't automatically mean that the information they're presenting
• 9:47
  is wrong, but there's a clear financial motivation and bias there.
• 9:53
  So, I would be cautious.
• 9:56
  And the next thing is, are they encouraging you to seek care if, you know,
• 10:03
  it makes sense or if things don't add up?
• 10:05
  So again, this is kind of feeding back into the idea of nuance.
• 10:10
  You know, they might present things in a certain way that's digestible.
• 10:13
  But ultimately, like, are they still suggesting if things don't fit this
• 10:17
  neat, you know, template of what they're presenting, like you should go seek
• 10:22
  care with your individual provider.
• 10:25
  Host: Yeah.
• 10:25
  That last point, it definitely seems especially important where it's like good
• 10:31
  information should lead you to a next step and not necessarily, like, replace care.
• 10:38
  Adi Rattner Nevo, MD: Definitely.
• 10:39
  And it can help you maybe recognize a pattern or like make some sense of the
• 10:45
  symptoms, the experiences that you're having and put the words to them,
• 10:50
  and help you feel seen, recognized.
• 10:54
  It does not take the place of, you know, having a provider talk to you and
• 10:59
  do a really comprehensive assessment of what is going on with your health.
• 11:04
  Host: I am going to keep talking about my algorithm, which is deeply
• 11:11
  invested iin this conversation, which, you know, it's gotten rid
• 11:16
  of all of my heated rivalry reels.
• 11:18
  Now, it's just all perimenopause all the time.
• 11:22
  So now, that I'm being fed all of these things, I want to benefit our
• 11:26
  audience and make sure that we are separating the truth from the fiction
• 11:33
  on the reels that are coming up, because I'm sure it's not just me.
• 11:38
  So, let's get to a little bit of a lightning round of questions.
• 11:44
  I'm going to read some statements that have come up in the course of my
• 11:50
  research here, and I just want you to kind of tell me if they are true, like
• 11:56
  generally accurate, or false, or just misleading, or just kinda incomplete.
• 12:03
  So, are you ready for the lightning round?
• 12:06
  Adi Rattner Nevo, MD: Yes.
• 12:07
  Host: Okay, great.
• 12:09
  Let's start with this one.
• 12:11
  If you're 35 or older and suddenly experiencing fatigue, anxiety,
• 12:16
  and brain fog, that's a sure sign that you are in perimenopause.
• 12:22
  Adi Rattner Nevo, MD: I would say false.
• 12:24
  Those symptoms can occur in perimenopause as we, you know, talked earlier, but they
• 12:29
  can also be caused by other conditions.
• 12:32
  And so, especially I think you said suddenly experiencing, I would definitely
• 12:39
  want this individual to get checked and ruled out for other conditions.
• 12:44
  So, that's what I would say.
• 12:45
  Host: Okay.
• 12:46
  All right.
• 12:47
  Question two or statement two.
• 12:51
  If your periods are still regular, you can't be in perimenopause.
• 12:57
  Adi Rattner Nevo, MD: False.
• 12:58
  So, changes in the cycle pattern are common in perimenopause and
• 13:02
  some people will experience those.
• 13:05
  But sometimes the other symptoms can begin before periods become
• 13:11
  irregular or people notice any change in their menstrual bleeding.
• 13:15
  So, regular periods don't completely rule out the beginning or, you
• 13:19
  know, the presence of perimenopause.
• 13:21
  Host: All right.
• 13:21
  This next question I am extremely, extremely invested in.
• 13:26
  Hair shedding in your 40s, is it often part of perimenopause?
• 13:31
  Adi Rattner Nevo, MD: I would say this statement maybe is incomplete.
• 13:34
  Hair changes can happen during perimenopause, but hair shedding
• 13:38
  could be caused by other conditions.
• 13:40
  Again, so thyroid problems, stress, iron deficiency, nutritional issues,
• 13:46
  some medications or other, you know, skin or scalp conditions.
• 13:51
  So if, you know, hair loss feels significant, or, you know, sudden
• 13:56
  or new, it's definitely worth coming in to talk to one of the providers
• 14:01
  Host: I'm going to carefully monitor that.
• 14:04
  Next statement.
• 14:05
  If your provider won't run a full hormone panel, find one that
• 14:10
  actually understands perimenopause.
• 14:13
  Adi Rattner Nevo, MD: I would say false, and I know this may feel contentious.
• 14:17
  But, you know, what I talk about with my patients and when we talk
• 14:22
  about the meaning of certain labs, hormone levels can fluctuate a
• 14:26
  lot during me- perimenopause.
• 14:28
  So, a single lab value at one point in time or on one day
• 14:33
  may not tell us very much.
• 14:34
  And in many cases, you know, it may be in the premenopausal range or, you know,
• 14:41
  what we'd consider normal in premenopause.
• 14:44
  So in many cases, our care and our decision to start different types of
• 14:49
  treatments is based more on the symptoms, the medical history, someone's age,
• 14:54
  possibly menstrual changes, you know, ruling out other medical conditions.
• 14:58
  And we go based more on that than necessarily the lab value.
• 15:02
  So, testing can be useful, in some situations, specifically,
• 15:07
  you know, regarding hormone level testing, but sometimes it doesn't
• 15:12
  necessarily add too much to the care
• 15:15
  I did want to address, you know, the feeling of if your provider won't run
• 15:19
  a full hormone panel, find someone who actually understands perimenopause.
• 15:23
  I will say most importantly is finding a provider with whom you feel like you can
• 15:30
  openly talk about your experiences and symptoms and feel validated and heard.
• 15:35
  You know, then talking about what, you know, what data we have and the
• 15:42
  research supporting, you know, different decisions and treatment approaches.
• 15:46
  But very important, especially as this period of time can come with changes, as
• 15:53
  we said, in mood and, you know, cognitive function and other things, other symptoms
• 15:59
  that are really meaningful to people's day-to-day experience, is finding
• 16:03
  someone that you feel comfortable with.
• 16:06
  Host: It kind of comes back to it really is kind of like peri, it's that
• 16:10
  kind of like shruggie pause, you know?
• 16:12
  It's like it's up and down all the time.
• 16:16
  So, that makes a lot of sense.
• 16:18
  Kind of related to that, and this is definitely one that this
• 16:23
  phone, it wants to sell me stuff.
• 16:26
  I'm getting two conflicting statements.
• 16:30
  Everyone in perimenopause needs hormone replacement therapy.
• 16:34
  But conversely, nobody in perimenopause needs hormone replacement therapy.
• 16:41
  Adi Rattner Nevo, MD: So, both are false.
• 16:43
  And I think, you know, we talked about absolute statements.
• 16:45
  And I will say hormone therapy can be very helpful for some people, and
• 16:50
  it's also not right for everyone.
• 16:52
  So, there are benefits and there are some risks.
• 16:55
  And so, treatment depends on the symptoms, health history, goals,
• 16:59
  risk factors of individuals.
• 17:01
  And this is where I say it's really important to feel comfortable
• 17:05
  with your provider navigating kind of both the benefits and the
• 17:08
  risks in making that decision.
• 17:10
  Host: That's very well said.
• 17:12
  And I'm happy to say I feel like we work at a place, I feel like MIT Health,
• 17:19
  you're going to find your person.
• 17:20
  I think we got a good crew.
• 17:23
  This one that's come up, I think this is fascinating.
• 17:26
  There's this very popular theory that a lot of women are getting diagnosed
• 17:34
  with ADHD and autism in their 30s and 40s, and they're noticing the
• 17:39
  symptoms because of perimenopause.
• 17:42
  Adi Rattner Nevo, MD: So, that statement I would say is incomplete.
• 17:45
  Hormonal changes, sleep disruption, stress, and the general demands of
• 17:50
  midlife can absolutely impact focus, mood, memory, and coping skills.
• 17:56
  And so for some women, it's the time where maybe long-standing ADHD becomes
• 18:02
  harder to compensate for or finally kind of reveals itself or is recognized.
• 18:08
  But it is important to remember that perimenopause
• 18:11
  does not cause ADHD or autism.
• 18:15
  So, the symptoms like brain fog, difficulty concentrating, and fatigue
• 18:19
  can have lots of explanations.
• 18:21
  That is what makes it kind of nuanced and maybe challenging to figure out.
• 18:25
  So, this is something that is really important to give a thorough evaluation
• 18:31
  and, you know, just to have caution with what little bite-sized recommendations are
• 18:39
  found online on reels or Instagram post.S
• 18:43
  Host: For sure.
• 18:44
  For sure.
• 18:44
  i have a final statement in our lightning round.
• 18:47
  This has been awesome.
• 18:49
  This one's been everywhere.
• 18:51
  I think the New York Times wrote about this.
• 18:53
  In fact, I know it did, because I read the article.
• 18:56
  So, it's this TikTok, Instagram thing, that a simple combination of an
• 19:03
  antihistamine and an acid reducer can help with lots of perimenopause symptoms.
• 19:11
  Adi Rattner Nevo, MD: I would say incomplete for this statement.
• 19:15
  You know, you can find a lot of anecdotal or like case discussion online about
• 19:20
  this combination of medications.
• 19:24
  But this is not the standard of care for most perimenopause symptoms.
• 19:28
  And so, I would caution people against, you know, self-treatment
• 19:34
  based on internet advice.
• 19:36
  There may be some risks.
• 19:37
  You know, while these medications are both available over the counter,
• 19:42
  they're not without long-term risks.
• 19:44
  If you're not sure or really seeking, you know, remedies for the symptoms
• 19:48
  you're experiencing, I would, again, come talk to your medical provider
• 19:55
  before attempting a treatment like this
• 19:58
  Host: .So,
• 19:58
  I think that that is a really great segue into kind of like talking about—because
• 20:04
  I think that for a lot of people it's a little hard to decide when the moment
• 20:09
  is that it's like, "This is my moment.
• 20:12
  I need to talk to a clinician.
• 20:15
  I need to stop talking to my best friend ChatGPT, and I need to actually talk
• 20:21
  to somebody at MIT Health perhaps.
• 20:24
  Is this something to bring up at a routine appointment?
• 20:28
  Should you make a specific appointment to come in to talk about this?
• 20:34
  It's how armed with information and symptoms should you be before
• 20:41
  you make that appointment and come in and talk to a clinician?
• 20:48
  Adi Rattner Nevo, MD: My inclination is to say, you know, if you're noticing
• 20:53
  a change in your body and how you're feeling, you know, in your concentration,
• 21:00
  noticing brain fog, anything, any of the symptoms we talked about, it's very
• 21:05
  reasonable to come schedule an appointment just for that, even if you're not due
• 21:10
  for your physical until, I don't know, six months from now or whatever it is.
• 21:15
  Even if the symptoms maybe still feel vague and challenging to describe,
• 21:19
  it's something that's worth coming in and making a plan of how this will
• 21:23
  be evaluated and like what are next steps, when will we check in again.
• 21:28
  That's what I would say.
• 21:29
  We're always here.
• 21:30
  And I sometimes have patients kind of like apologizing because they feel like
• 21:34
  what they came in for is not a big deal.
• 21:36
  But I think any change that you're noticing is worth exploring,
• 21:40
  even if ultimately it resolves and we say, "This wasn't it.
• 21:44
  This was not a different medical condition or perimenopause."
• 21:48
  You know, it's great to have awareness and if something changes differently in
• 21:52
  the future, we've already touched base.
• 21:54
  Host: Such a beautiful way to answer that question.
• 21:55
  And, you know, I think that
• 21:59
  it's really hard.
• 22:00
  I relate to a person who comes in and apologizes, because sometimes
• 22:06
  you feel like I need to prepare a PowerPoint presentation of evidence
• 22:10
  because it's like, you know, we know that it's like everyone in
• 22:14
  healthcare, your time is limited.
• 22:16
  So, it's like, "I need to make this count.
• 22:18
  It's important."
• 22:20
  So, that's really helpful to know that it's like I don't necessarily need to
• 22:25
  bring, you know, a mountain of evidence.
• 22:27
  I can just bring my concerns to an appointment.
• 22:32
  Adi Rattner Nevo, MD: Absolutely.
• 22:32
  And I think that's the beauty of primary care is that we have the
• 22:35
  ability to follow up with you and kind of determine what that looks like.
• 22:40
  you don't have to have the diagnosis all figured out before you come to see us.
• 22:44
  That's partly our job and, obviously we partner with you.
• 22:47
  But, you know, that is our entire job.
• 22:50
  So, it's okay if things aren't so clear yet and we'll make
• 22:54
  a plan to figure it out.
• 22:56
  Host: That's awesome.
• 22:56
  I mean, our MIT audience, they kind of want to have it all figured
• 23:03
  out before they come into any situation, which is why we love MIT.
• 23:09
  But we can help.
• 23:10
  You don't have to have everything figured out before you come in.
• 23:14
  Adi Rattner Nevo, MD: I think one very important thing that, you know, I'm seeing
• 23:18
  online is a lot of services that are, you know, providing prescription for, you
• 23:25
  know, menopause hormonal treatment and additionally like weight loss injections
• 23:30
  and for many different indications.
• 23:33
  And it's just kind of blowing up of compounding pharmacies online, and
• 23:39
  patients have access for quite a lot of money to some of these medications.
• 23:44
  And I would just say that, you know, we don't have enough information about how
• 23:49
  these pharmacies are being regulated.
• 23:51
  if you are considering getting those medications, I really do recommend
• 23:55
  that you come talk to us first, and we can hopefully help develop a
• 23:59
  treatment plan that feels right for you.
• 24:03
  Many of the providers now at MIT Health feel comfortable prescribing
• 24:07
  menopause hormone treatment.
• 24:09
  We can address the fact that our mothers and grandmothers maybe didn't
• 24:13
  have access to this for reasons of probably history of medical research.
• 24:19
  And that's a whole other, I think, podcast.
• 24:23
  But we do have access to high-quality data now and feel comfortable
• 24:30
  prescribing this as is appropriate.
• 24:32
  And so, we're here for you and, you know, can come up with a treatment plan
• 24:37
  and hopefully one that doesn't leave people spending hundreds of dollars
• 24:42
  online after an evaluation of several minutes by maybe not a live provider.
• 24:50
  Host: Thank you for pointing that out because I think that's another
• 24:53
  thing that it's really important to understand is, like, you know,
• 24:58
  we all live on the internet.
• 24:59
  We've all seen these ads.
• 25:00
  We've all seen these ads everywhere.
• 25:05
  And if you have had a moment where you clicked on something and went through
• 25:10
  an evaluation, that's not a moment to be embarrassed and not to feel comfortable
• 25:17
  talking to your clinician about that.
• 25:19
  And so, in fact, i if you have those moments where, you know, you filled
• 25:26
  out an online form and suddenly you're getting emails with discount codes,
• 25:29
  it's okay and not embarrassing to talk to your clinician about that.
• 25:36
  No one's going to shame you.
• 25:38
  You know, we all live in this world.
• 25:40
  We all see the same content, and it's totally okay to take a beat
• 25:48
  before you put in your credit card info and say, "Hang on.
• 25:53
  Maybe this is a moment to talk to somebody at MIT Health.
• 25:57
  Maybe this is a moment to talk to my clinician."
• 26:00
  So, thank you so much for bringing that up because it feels
• 26:05
  like every time you look, there's even more of it.
• 26:08
  So, that's definitely something that is a trend.
• 26:12
  Thank you so much, Adi, for being on this episode.
• 26:15
  I'm sure we will have you back soon.
• 26:18
  We have plenty of other topics.
• 26:21
  Maybe we can have one on the history of mental health of women's health research.
• 26:26
  I think that would be fun, who knows?
• 26:28
  But if you have a question for, office hours, please visit health.mit.edu/thrive
• 26:36
  to submit your question via our online form.
• 26:39
  And until next time, be well, and don't let your Instagram algorithm
• 26:44
  replace your primary care provider.