Latest / Women's Wednesday with Susan Tran / Women’s Wednesday: Let's Talk About Perimenopause

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Women’s Wednesday: Let's Talk About Perimenopause · Women's Wednesday with Susan Tran

0:03
Hi, everyone. Susan Tran here from DC News Now.
0:06
We're going to start a new segment. It's Women's
0:09
Wednesdays, where we're going to talk about things
0:11
that our girlfriends and all of us like to kind
0:14
of tackle together so we don't kind of feel alone
0:17
in some of the experiences that we're having.
0:20
And once a month, we have the pleasure and the
0:23
honor of having a gynecologist with us to talk
0:26
about perimenopause and menopause. And joining
0:29
me now is Dr. Nadine Hamoud. Hi, Nadine. Hi,
0:33
Susan. and thank you for having me. This is so
0:36
exciting that you are so generous to give us
0:39
your time to talk about this really important
0:42
subject. I guess we have to really start and
0:46
figure out what is perimenopause and what is
0:50
menopause and how are they different? Well, Susan,
0:54
first I truly want to applaud you for just actually
0:56
taking the initiative to reach out because this
0:59
is such an important topic in our 21st century.
1:02
So really good job that you are initiating this
1:05
great segment. So yes, let's talk about perimenopause.
1:09
Perimenopause, I'm joking, this is like the buzzword
1:12
of the century, along with like HRT, right? Everyone
1:15
wants to talk about perimenopause and HRT, and
1:18
yes, we do need to talk about it. So let's first
1:20
start with what is perimenopause? So think of
1:23
perimenopause like the transitional phase years
1:26
that precedes menopause. the follow -up question,
1:29
then, what is menopause? So menopause is the
1:33
official 12 months of no period, so meaning no
1:37
menstrual cycles for 12 months. Then all the
1:40
years that precede that 12 months are called
1:43
perimenopause. So think of it like transitional
1:46
years leading up to that 12 months. I usually
1:50
jokingly say that it's a reverse puberty. So
1:53
think of in puberty, we have a sudden rush of
1:57
hormones. ovaries are producing a flood of hormones
2:01
to our body, and it can affect us from head to
2:03
toes. So think of perimenopause as the reverse
2:06
of puberty, but hopefully with better life choices
2:09
and better costumes, too. The ovaries start to
2:13
produce less and less hormones, mainly estrogen
2:16
and progesterone, and it can affect us the same
2:19
way, head to toes, inside out. So that's really
2:23
the basic... really basic crash course about
2:26
perimenopause, but it can cause a lot of symptoms,
2:30
physical symptoms, psychological symptoms, and
2:33
then we'll definitely talk more about these in
2:35
a second. Well, let's talk a little bit about
2:38
the idea that there are just so many symptoms.
2:42
We were having our conversation on the phone
2:45
maybe a few months back. And you said something
2:49
that just made me laugh. You're like, everything
2:51
could point back to perimenopause or menopause.
2:54
So if you think about it, Susan, we have hormone
2:58
receptors from head to toes. And that's really
3:01
what have been such a misunderstanding among
3:03
patients or even doctors and specialist providers.
3:08
we have hormone receptor from head to toes, meaning
3:10
if you're having hair loss or if your big toe
3:13
is hurting, you can blame it on perimenopause.
3:16
But I'm still going to say, please go see your
3:18
podiatrist for that big toe that's hurting. But
3:21
medically speaking, biologically speaking, yes,
3:24
we do have hormonal receptors everywhere in the
3:28
body and our organs. So if you think about it,
3:31
once those hormonal shifts, and again, those
3:33
overs are producing less hormones, those organs
3:36
will get affected because they're not getting
3:38
the, think of hormones like the supplements to
3:41
the body. So once we start getting less of those
3:44
hormones, then all the body and its physiology
3:47
is going to change. And I can name at least 20,
3:51
50 symptoms. So I usually try to categorize them
3:56
into physical symptoms, physiological symptoms,
4:00
and emotional or psychological symptoms. So really
4:03
if I just want to scan the body from head to
4:05
toe. So you can have hair loss. You can have
4:08
dry skin. You can have itchy eyes, dry eyes,
4:12
itchy ears, believe it or not. Some patients
4:14
might have tinnitus or ringing in the ear. TMJ
4:20
gets worse. We can have palpitations. Digestive
4:24
issues or digestive changes. Going down the body,
4:29
obviously cycle changes, period changes. you
4:32
know, sexual desire gets less, vaginal dryness,
4:37
joint pain, you know, more frozen shoulder. We're
4:39
seeing a lot of frozen shoulders in pregnant,
4:41
I'm sorry, in perimenopause. So think of it that
4:44
those hormonal shifts are on a roller coaster.
4:48
I always tell patient that, and please, you are
4:50
not crazy, you are not losing it. It is real.
4:54
It's just like think of it, the hormones are
4:56
all over the place. You can't tell if you're
4:58
waking up with a big smile, today's going to
5:01
be a good day. Or like, I hate the world and
5:03
I want to stay in my bed. So yes, I hear you.
5:06
There is treatment for that. And we definitely
5:09
need to acknowledge that probably your hormones
5:12
are playing musical chairs on you. So it's not
5:14
in your head, I promise. Oh my goodness. OK,
5:17
so A, you're just validating all of these symptoms
5:21
that I feel like my girlfriends and I, all we
5:24
talk about is I don't know. My hair is thinning.
5:27
I feel awful. Sometimes I'm just crabby. I'm
5:31
hungry. I'm so tired. And we just don't realize
5:37
it. And at one point, I always tell my friends
5:40
because I was really anxious about all of these
5:42
things and I made sure to talk to my doctor.
5:45
And I turned to my other girlfriend, and I was
5:47
like, you need to talk to your doctor. Like,
5:49
it's not enough to just have conversations. It's
5:51
not enough just to read about it. You have to
5:54
speak to a professional. Thank you. Thank you.
5:56
This is 100 % true. Perimenopause doesn't, again,
6:01
only affect physical symptoms, like I just mentioned,
6:04
because it affects the woman, most importantly,
6:07
and some of the emotional or psychological symptoms
6:10
that can honestly, also get affected in perimenopause
6:14
that also get dismissed. For example, brain fog,
6:18
and it's like the famous, I walked into the kitchen,
6:20
but I don't know why I'm here. The worsening
6:23
depression, worsening anxiety, you know, panic
6:26
attacks, crying spells, all of that can also
6:30
be affected by perimenopause. Perimenopause affects
6:34
the woman, obviously most importantly, our patients.
6:37
But also, it's a dominant effect. It can affect
6:39
her relationship and a partnership. At work,
6:44
I often hear patients telling me, like, my boss
6:47
took me on the side and was like, you're very
6:49
irritable. You're snapping at everyone. Like,
6:51
what's going on? And she didn't even realize
6:53
that. Another patient was like, my husband asked
6:57
me, like, am I getting the, let's say, happy
6:59
Susan today? Or am I getting, like, don't talk
7:02
to me today? So, it's a domino effect. It can
7:05
affect a lot of things, mainly the patient. So,
7:09
yes, please have your girlfriends and the audience
7:12
out there, please talk to us. Talk to your doctor.
7:15
And if they're not specialized in perimenopause
7:17
and menopause, there are a lot of specialists
7:20
out there. You can find them on the NAMS website
7:23
or the Menopause Society website. You can just,
7:26
like, put in the zip code and you can just find
7:28
all the providers, specialists, doctors that
7:30
are certified in treating perimenopause. Because
7:33
I think what a lot of women maybe experience
7:37
now or had experienced, sometimes it's kind of
7:42
brushed off. It's like, well, you know, you're
7:45
going through a lot of stress. You have a child
7:47
maybe going to start school or you are starting
7:51
a new job. And these are all the reasons that
7:53
it could be. And so you kind of feel like, OK,
7:56
maybe I am. Maybe I am losing it. Maybe I'm becoming
8:00
forgetful because I have too much on my plate.
8:03
Or maybe my hair is thinning because I'm stressed.
8:06
Or maybe my back hurts because my posture is
8:10
horrible at this point. But at what point do
8:13
we have to just acknowledge that it could be
8:16
something like perimenopause and that we should
8:18
talk to a professional? Yeah, very good question,
8:20
Susan. Thank you. Obviously, always talk to your
8:23
doctor about it. Start, obviously, with your
8:25
primary care provider, because I say that perimenopause
8:30
is a great mimicker, and I wish that can go,
8:33
again, on the headlines, the great mimicker of
8:36
disease. Like, again, you can literally blame
8:38
everything on perimenopause, but at the same
8:40
time, yes, please, if your ears are ringing,
8:42
go see the ENT. If your back is hurting, you
8:45
know, see a dermatologist. But how can someone
8:48
tell that they might be experiencing perimenopausal
8:51
symptoms or this is related to perimenopause?
8:54
The hallmark of it is change, right? So let's
8:57
start with change in the cycles, right? Change
9:00
in the mood, change in the sleep, like you are
9:02
doing so well and then all of a sudden you're
9:05
having those night sweats, those hormonal changes,
9:09
the worsening PMS, all of a sudden I'm fatigued
9:12
more. A lot of those symptoms can be confounded
9:15
with other medical conditions, so we always have
9:17
to rule out other medical conditions, you know,
9:19
obviously pregnancy or thyroid disorder. Or if
9:23
someone does have rheumatoid arthritis that is
9:25
undiagnosed. So again, the perimenopausal symptoms
9:28
mimic a lot of other medical conditions, so we
9:31
don't want to dismiss those. But at the same
9:34
time, also do your gynecological well -women.
9:37
The GYN exam should be on a yearly basis. You
9:42
know, the fault is on us sometimes. Unfortunately,
9:45
doctors and a lot of specialists and providers,
9:47
they might not ask about these because they do
9:49
not know that this can be connected. But if you
9:52
ruled all of the things with your primary care,
9:54
this is where, like, we have to talk about perimenopause,
9:57
and this can be related to perimenopause. So
10:00
please have open discussions with your specialists,
10:03
with your doctors, and then ask to get tested.
10:07
There's no single test. Susan, about perimenopause.
10:10
So it's not like diabetes. Diabetes is very easy.
10:13
Where A1C is in this level, that's it. You're
10:15
marked as diabetic. In perimenopause, yes, we
10:18
can get some hormonal check. But unfortunately,
10:21
the hormones fluctuate by the hour, by the minutes.
10:23
And again, just think about it being on a roller
10:26
coaster. So depending where we catch the patient,
10:29
they might not be as accurate. But it's still
10:31
important just in special situation to get them
10:34
checked. So perimenopause is more diagnosed based
10:37
on history, symptoms. We do actually have a perimenopausal
10:41
risk score, if that makes sense. So I encourage
10:45
the audience to go online and just look up menopausal
10:48
score risk. And it has over 20 of the symptoms
10:52
that I just described. And then they might actually
10:55
relate to that score. Take it to your doctors
10:58
and say, I'm experiencing this. Can you help
11:00
me with that? Definitely rule out other more
11:04
concerning medical conditions, but at the same
11:07
time, please keep in the back of your mind that
11:09
it could be perimenopause. And it can start as
11:13
late 30s, so this is why I agree a lot of patients
11:16
get dismissed, like, oh, you're too young to
11:18
have this. Well, actually, you can start perimenopause
11:22
late 30s, early 40s, and some patients might
11:26
start at early 50s. So going back, think of it
11:28
like a reverse puberty. Some patients might start
11:32
puberty at age 9, and some patients might not
11:34
have their first period till age 17. Such a wide
11:37
range. Same principle. Those hormonal changes
11:40
can happen at any time. Like perimenopause doesn't
11:44
check your calendar. It's inconvenient for me
11:48
right now. It doesn't, unfortunately. I wish,
11:51
I wish. But yes, talk to a specialist that is
11:55
specialized in perimenopause that listens to
11:57
you. that won't, you know, dismiss your symptoms
12:00
and then, you know, get that perimenopausal or
12:04
the menopausal risk score. You might find it
12:07
eye -opening and you might feel like, oh my God,
12:09
I'm having all those symptoms. And finally, you
12:12
know, patients often go to many doctors, many
12:14
specialists, and they say like, no one's figuring
12:17
out what's going on with me. So yes, please have
12:20
open conversations and talk to your doctors about
12:23
it. Can you just talk a little bit more about
12:25
this age range? I think one of the things that
12:29
people are just shocked by is that it can start
12:31
in your late 30s. Because when I was telling
12:35
folks about my real desire here to talk about
12:39
perimenopause and menopause, it was kind of like,
12:42
oh, that's such an old lady thing to discuss.
12:45
And it's not really impacting kind of like our
12:48
age group or the people that are my friends or
12:52
my peer group. It is way earlier than we talked
12:57
about or we even knew about. Is this a new thing
12:59
or is this just something that we're realizing
13:02
and it's coming to the forefront at this point?
13:05
I agree. It's actually we're realizing now that
13:08
it actually can start much earlier, but probably
13:11
you're right. Like it got dismissed. Like you're
13:14
too young. It cannot be perimenopause. I feel
13:18
like unfortunately we don't talk much about perimenopause.
13:21
Many, many reasons I can think of. A, we women,
13:26
again, we think that perimenopause is like me
13:29
getting older, and we want to always stay young.
13:33
So they don't talk about it. They don't want
13:34
to share that I'm having hot flashes, I'm having
13:37
night sweats, I'm having cycle dysregulation.
13:41
So they feel ashamed, but at the same time, maybe
13:44
I shouldn't be talking about it. It's so personal.
13:48
The other reason is taboo in the society. I feel,
13:51
unfortunately, everything related to women's
13:53
health has always been a taboo. We don't talk
13:56
about periods. We don't talk about what's normal,
13:59
what's heavy. Believe it or not, I have patients
14:02
in their 60s. I have posters around my office
14:05
showing anatomy. And some patients don't even
14:08
know, oh, so this is where my ovary is. This
14:10
is where my tube is. We don't talk about sexual
14:14
health. you know obviously if it was for men
14:16
then like you know it will be online everywhere
14:19
and we would be inventing a lot of medication
14:21
for it like you know centuries ago but unfortunately
14:23
because we women were are always like on the
14:26
side so we don't we didn't talk much about because
14:29
it's a taboo and lastly I would say we as doctors
14:34
and even like a lot of providers and specialists
14:36
we don't get enough training which is the ugly
14:39
truth but I'm going to say it and put it out
14:42
there, we do not get enough training about perimenopause
14:45
and menopausal treatment, which is changing now.
14:49
There are a lot of studies recently and surveys.
14:53
A lot of doctors did not feel comfortable. Even
14:55
talking about doctors that might actually graduated
14:58
obstetric and gynecology residency, they said
15:00
they were not very comfortable, and that's why
15:03
we do have to get this extra certification to
15:05
get this. This, though, has been changing. which
15:08
is good. So a lot of the medical schools have
15:10
been incorporating perimenopausal HRT treatment
15:14
in their programs. You know, this school obviously
15:17
system is changing, so hopefully this will improve
15:20
with time. So I would think about all those factors,
15:24
Susan, when I talk about why don't we talk about
15:27
it, right? What are the reasons? And this is
15:29
why maybe patients would think that, oh, maybe
15:31
it's too early, but it is not too early. It's
15:35
just like once the ovaries decide that I don't
15:38
want to produce, I don't want to work anymore,
15:40
I'm taking a break. And then it might wake up
15:44
again and say, you know what, I'm done from my
15:46
hibernation. I will start working again. So we
15:50
can switch on and off. Correct. It ebbs and flows.
15:52
Oh, goodness. I'm sorry. A lot of patients would
15:57
feel like some months I feel just fine. And then
16:00
other months I feel like, you know, I'm having
16:03
all those symptoms. Again, going back to this
16:05
roller -coaster ride, your hormones are really
16:08
just like playing music chairs on you. But other
16:11
factors can influence, obviously, when someone
16:14
can go into perimenopause earlier. It can be,
16:18
let's say, smoking can obviously harm the eggs.
16:21
So the ovaries will produce less egg. The quality
16:24
and the quantity of the egg will get worse. Someone
16:27
who had unfortunately experienced cancer and
16:29
needed chemotherapy or radiation to the pelvic
16:31
area that can unfortunately also decrease ovarian
16:35
volume and obviously ovarian function. Some medical
16:39
conditions can also affect the ovaries like autoimmune
16:42
disease. So this is why please have your regular
16:45
checkups every year with the primary care and
16:48
with the gynecologist to talk about those hormonal
16:51
symptoms and issues. Okay, so just so we're talking
16:54
about perimenopause can start, it can stop, but
16:58
to get into menopause, you would need to be in
17:01
a full 12 months of perimenopause? You have to
17:06
be, so menopause is 12 months of no period. Menopause,
17:10
full menopause. Correct, so everything before
17:12
those 12 months, the years. that are called perimenopause
17:16
and again it can start late 30s till you get
17:18
this 12 months of no periods which could be up
17:21
to age 55 okay and so then these symptoms all
17:27
of them the mirrored symptoms so many symptoms
17:30
they can last through perimenopause into menopause
17:35
correct yes so even after you get those 12 months
17:39
of no periods it's not a switch on and off so
17:42
A lot of patients might still get hot flashes
17:45
even after they get those 12 months of no period.
17:48
So I hate to say this, but when you get those
17:51
12 months of no period, it doesn't mean that
17:53
I'm done. You still can get those symptoms of
17:57
hormonal deficiency. Again, the ovaries stop
18:00
producing the estrogen and progesterone, and
18:04
it can affect the body in the same way. So you
18:07
might still have the brain fogging as you can
18:09
still have the hot flashes, night sweats, sleep
18:12
issues, the low sexual desire, the vaginal dryness.
18:17
So it's unfortunately those lower level of hormones
18:20
and going back that the organs have hormone receptors
18:24
all over. So just think of it when you have iron
18:27
deficiency, right? So if you have iron deficiency
18:30
and you are having symptoms of low iron, what
18:34
do you do? You need to supplement yourself with
18:36
iron, right? And hopefully your symptoms improve.
18:39
So it's the same principle. When the body doesn't
18:42
have enough of those hormones, then you will
18:45
manifest those symptoms. OK, and so we have,
18:49
it could be a couple of years of perimenopausal
18:53
symptoms, right? Or it could be 10 years or 15
18:56
years. OK, that's what I was going to ask. Because
18:58
then we're in menopause, and then we could have
19:02
a couple of years of symptoms there as well?
19:04
Correct. So this whole period could be be into
19:08
the 10 -year span? Correct. Yes. So I always
19:12
tell the audience or my patients that let's first
19:16
start with the definition of menopause. Let's
19:18
say menopause is this 12 months of no period.
19:21
The years before that is perimenopause, and the
19:23
year after this 12 months is postmenopausal period.
19:27
And yes, those symptoms can last through the
19:29
postmenopausal years as well. Not necessarily
19:32
like everyone will have it. Again, going back
19:35
to just puberty, You know, you can't stop getting
19:38
acne by your 20s, or you might have acne all
19:42
your life, right? Same thing. In post -menopausal
19:46
years, some patients might tell me, oh, I had
19:49
one hot flash, and that was my menopause. And
19:53
I was like, I want to be you when I grow up.
19:55
I'm so envious. Did someone really say that?
19:58
You had a patient. I know. So fortunate. I really
20:02
want to be you when I grow up. You're my new
20:04
role model. And I have patients who literally
20:07
like you know late 30s and like they're sweating
20:10
and drenched in front of me So that's the ugly
20:14
truth, but we can talk about the treatment next
20:18
so you don't have to suffer We do have treatment
20:21
for that. So don't feel bad Okay, that's one
20:24
of the things that I had talked to one of my
20:26
girlfriends about is she was Having all of these
20:30
symptoms and I was thinking I think this is perimenopause.
20:34
I think this is really awful that you're experiencing
20:39
all of these symptoms and you don't have to suffer.
20:43
And she was so hesitant to see a doctor because
20:46
no one else can help you. I mean, you can read
20:48
all the facts and everything, but the truth is
20:50
to get some of the treatments that can really
20:53
help, you do need to see a physician. You need
20:57
to see a specialist. Talk about some of the hormone
21:01
therapies that are available and why so many
21:04
people are so resistant. So I usually say to
21:09
patients that perimenopause, menopause, the symptoms
21:11
that you're going through is a natural phase.
21:14
So it's not a disease that needs to be treated.
21:18
But at the same time, the symptoms can be, like
21:21
we talked about, bothersome enough that can affect
21:23
the quality of life. Not only the quality of
21:26
life, like just for You know, the relationships
21:30
we talked about, but also, like, physiologically,
21:33
it obviously can affect you. So it's a natural
21:36
phase. You don't have to suffer, and you don't
21:39
have, again, to suck it up. But what I tell patients,
21:42
like, I will empower you, and you should thrive
21:44
through it. There are many treatments of perimenopause,
21:48
whether, you know, just starting with lifestyle
21:50
changes, right? And the best lifestyle changes,
21:53
healthy diets, balanced diets, exercises. Even
21:57
just like walking every day, to be honest, for
21:59
like 10, 20 minutes, definitely brings up your
22:03
happy hormones and everything's connected. And
22:06
that's doable. Correct. Yeah, hopefully. Head
22:09
to toes, we're connected, right? So when we have
22:11
increase in the happy hormones, the endorphins,
22:14
then definitely it will affect in a positive
22:17
way our hormones. Weight bearing exercises, please
22:21
start weight bearing exercises. And then stress
22:24
management, I cannot stress enough how important,
22:27
I know it's easier said than done to tell people
22:29
don't be stressed, but mindfulness, meditation,
22:35
just take at least every day for yourself 10,
22:38
15 minutes. I can assure you that this is definitely
22:41
doable. So this is like the lifestyle changes
22:43
that can definitely help yoga, obviously acupuncture.
22:47
So this is what I usually tell patients, like
22:49
non -prescription ways, but lifestyle change
22:52
that can benefit you forever. But that's one
22:55
percentage of what you need to do, right? I would
22:59
definitely say a little bit more. I have a few
23:01
patients, they cut down on sugar and alcohol,
23:04
and they were like, my night sweats got better,
23:07
my hot flashes got better. Like the menopausal
23:10
belly fat that we have, especially in the lower
23:12
abdomen. Because that's fun. Oh my god. That's
23:15
a whole other story. Yeah. We women are lucky,
23:18
aren't we, Susan? Like, really seriously? Like,
23:20
is there something else that can happen to us?
23:22
Yeah, you want my hair to thin, you want my libido
23:25
low, and you want my belly fat. Like, what are
23:28
you doing to me? I'm dry, I'm hot, I'm sweaty.
23:33
I promise we've been good. Like, why is this
23:34
happening to us? Right. But to answer your question
23:38
about hormonal therapy, yes, hormonal therapy
23:42
are the mainstay of treating perimenopausal symptoms.
23:46
Again, I try to make it simple to my patient.
23:48
The example I gave about low iron store, and
23:52
you just need to supplement yourself with iron,
23:54
think of it almost the same. It's not like such
23:57
a simple equation, but almost the same. Your
24:01
body is not producing enough hormones. What do
24:04
you do? You supplement. Hormone therapy is the
24:07
main state of treatment for the right candidate.
24:11
Let me add that. Obviously, unfortunately, not
24:13
all patients are good candidates. You know, patients
24:16
who are breast cancer survivors, especially that
24:20
had ERPR, meaning estrogen receptor, and person
24:24
receptor positive, they might not be the best
24:27
candidate. And we have a whole list of contraindications
24:30
to hormones. But for the most part, with an HRT
24:34
or hormonal patient therapy or nowadays menopausal
24:37
hormonal therapy is safe. Actually, I would say
24:39
it's safer than we used to think. Decades ago,
24:44
doctors and patients were always told HRT is
24:48
bad. It can give breast cancer, uterine cancer.
24:51
We have newer studies, and we have a lot of older
24:55
studies. And we found that they're safer than
24:58
their use, we used to think. Not that, again,
25:01
we shouldn't individualize. And again, we still
25:03
have patients that are in this gray area. We
25:07
do have patients who are in the green zone. Yes,
25:09
you're a very good candidate. Please do not hesitate
25:12
to take them. and you have patients that are
25:15
in the red zone where like really it's contraindicated
25:17
and you have the patients in between and actually
25:19
most patients are in this gray area and this
25:22
is where it's not one size fits all. We have
25:25
many different types of protocols for HRT and
25:29
then we just have to individualize care. It's
25:32
not like you know I wish I can be like Oprah
25:35
like you get HRT and you get HRT and you get
25:37
HRT like obviously you have to individualize
25:40
but For the most part, HRT are safer for the
25:46
right candidate and also with the right specialist
25:49
that is treating that. Right. And again, it's
25:52
important to stipulate. You should go see your
25:54
doctor to see if you have any of the risk factors
25:58
that would put you on the red zone or if you're...
26:00
Probably like the majority, you're in the gray
26:03
or the green zone, right? Correct. And just so
26:06
people can understand, hormone replacement therapy,
26:11
it's not a shot, right? It's usually a patch
26:13
these days? Correct. So we have many protocols
26:16
for, well, let's first start HRT again, hormone
26:20
replacement therapy or menopausal hormonal therapy.
26:23
Mainly, they're estrogen and progesterone, and
26:26
then plus hormonal testosterone, which we can
26:28
definitely talk about at a later segment. But
26:32
the main, like at least FDA approved, are the
26:35
estrogen and the progesterone. The safest way
26:39
to give estrogen, like the non -oral route, and
26:43
so the transdermal right, your right, Susan,
26:46
would be probably the preferred method to start,
26:49
again, for the right candidate. So it's just
26:51
like an adhesive tiny sticky patch that you know
26:54
patients can put on their skin Usually it's replaced
26:57
twice a week and then the progesterone could
27:00
be delivered with any other method whether the
27:04
pill or a cream or An IUD the Mirena or the lilata
27:08
IUD So many many nice protocols the estrogen
27:12
can also be delivered by a ring or a gel or a
27:16
cream We do also have additionally Vaginal estrogen,
27:20
which is so important for many, many patients
27:24
who suffer from vaginal dryness, painful intercourse,
27:27
and it actually can help with urinary incontinence,
27:30
by the way, so this is also an added benefit
27:33
that many patients do not know it exists. So
27:37
many protocols. We live, luckily, in 2025 where
27:41
we have... a lot of options, a lot of formulations,
27:45
and then we can tweak it depending on the patient's
27:48
symptoms, follow -up labs. Like I said, I usually
27:52
tell patients it's a journey. Again, I like to
27:56
give example just for the patients, because a
27:58
lot of people don't really, cannot understand
28:00
hormones and why we do what we do, so at least
28:03
for me, I try to explain to the patient in analogy
28:06
form. So just like diabetes, we're going to monitor
28:10
your symptoms, Check your sugar, see how it works
28:14
for you or not. Get the side effects. Are you
28:16
tolerating it well or not? It's going to be the
28:19
same with HRT. It's going to be a journey, and
28:23
your body will tell us, I like this protocol,
28:26
I don't like this protocol, I'm having the side
28:28
effect, or I feel like a day and night change,
28:31
which I hear all the time. And I usually, Susan,
28:33
love those follow -ups where patients say...
28:36
Oh my god, I wish I was on this way, way before.
28:40
Why didn't I ask about this earlier? Is that
28:43
really just the main protocol is HRT? Are there
28:48
supplements? Are there other things that... I
28:52
actually did start seeing commercials for things
28:55
that help with hot flashes specifically. So outside
28:59
of HRT, are there supplements or other medications
29:02
to help? So for patients who are not a candidate
29:05
for hormones, or they prefer not to enter that
29:09
route, we do have non -hormonal prescriptions.
29:13
So the SSRIs, SNRIs, like Paxil and Gabapentoclonidine,
29:19
all of that can be non -hormonal prescription.
29:23
What are they? So the SSRIs or SNRIs, so we do
29:28
have Paxil, we do have Wolbutrin, Clonidine,
29:31
Gabapentin. So these are non -hormonal prescriptions
29:35
that can also be given to patients who either
29:39
cannot take HRT for contraindication, or they
29:43
prefer not to, right? So some patients, maybe
29:45
they have a strong family history of breast cancer,
29:48
and they tell me, Dr. Hamoud, I really do not
29:50
wanna. Go that route. Obviously, I respect that.
29:53
But I still want to offer them other options.
29:55
Vevosa is also another medication that is strictly
29:58
for hot flashes. So we do have other alternatives,
30:02
so non -hormonal prescriptions. And then we talked
30:05
about lifestyle changes. And then the supplements,
30:09
yes, I agree. Like now they're listening on our
30:12
phones, like TikTok. And probably Facebook is
30:14
going to give us a lot. Oh my goodness, you're
30:17
right. So yes, nowadays if you open Google, you'll
30:22
find a million and one supplement. Supplements
30:27
definitely have a role in perimenopausal hormonal
30:30
treatment, but at the same time I tell patients
30:33
like we have to be careful because nothing that
30:35
is natural all the time is safe. Like, you know,
30:39
poison ivy is natural, but it's not really good.
30:41
Fair. And, you know, God knows where those supplements
30:44
are being made. You know, obviously, we don't
30:47
have the FDA approval. And they're not regulated,
30:50
correct? Thank you. Exactly. But in general,
30:52
like, you know, for the sake of the discussion,
30:54
like, we do know that black cohosh can help,
30:56
ashwagandha, adaptogens can help. But again,
30:59
like, please check with your doctor first, because
31:01
these can still cause liver dysfunction. They
31:04
can cause other side effects. So I don't want
31:08
to fix one thing. but unfortunately damage other
31:11
organs in the body. What are those supplements
31:14
for? So adaptogens can help regulate our hormones
31:18
indirectly. You know, fish oil can help, ashwagandha
31:22
can help, magnesium can help, also like for the
31:26
brain fog and it's for the sleep. So we do, I
31:28
do recommend actually magnesium glycinate for
31:30
sleep, especially at bedtime, to be taken at
31:33
bedtime. But at calcium vitamin D, vitamin D,
31:37
I would never say no to vitamin D for anything.
31:40
But again, check your levels first so you don't
31:42
over or increase excess of vitamins in your body.
31:46
Because anything that is in excess is as bad
31:48
as being too low. And when you were talking about
31:52
the other treatments that were not HRT, what
31:55
are they treating? Are they treating just symptoms?
31:58
So we do have few options. Like Vevosa is good
32:01
for hot flashes. OK. The SSRIs or SNRIs, some
32:06
of them can help also with hot flashes. It can
32:08
help with the worsening anxiety and mood that
32:11
we talked about in perimenopause, some of the
32:14
panic attacks that can happen, the crying spells.
32:18
And if you think about it, Susan, it's a domino
32:19
effect. So if you're sleeping better, if you're
32:22
not as anxious, all this nervous system that
32:25
is like it's extra excited and the body will
32:29
calm down and the domino effects happen. Like
32:31
you'll sleep better, your energy is better, you
32:33
will wake up feeling better, you might go for
32:36
a walk that day. So I would say they might indirectly
32:39
help, let's say HRT works on the estrogen receptors,
32:43
the other medication might work directly on the
32:46
brain receptors, right? Because these are medications
32:48
that are usually given for anxiety, depression,
32:51
PTSD, OCD, other types of trauma. So if we're
32:57
not able to address the hormones, then we can
32:58
address the aftermath of the hormone which is
33:01
on the brain, let's say. So it might affect the
33:03
brain receptors, and this is how it can help
33:05
with the symptoms. So it just calms down our
33:08
excited mind at the end of the night. I can't
33:11
believe that one of the symptoms is panic and
33:15
anxiety and crying. It spans the gamut. 100%.
33:23
And this is where I am a big believer in coordination
33:26
of care with other specialists, right? So I can
33:29
help with the hormonal factors, right? But if
33:32
someone has, you know, maybe undiagnosed ADHD,
33:35
which actually can get worse in petty menopause,
33:39
and we do have collaboration with some of the
33:42
psychiatrists. A lot of times, some of the psychiatrists
33:45
would refer their patients like, this patient
33:46
has been doing well on her medication, whether
33:49
for ADHD, whether for depression or anxiety,
33:52
and now The last few years, which around where
33:55
the patient starts having other symptoms of perimenopause,
33:58
the medications are not working. So this is where
34:01
we have to address the hormonal aspect. But I
34:05
still would want the patient, please stay with
34:07
your psychiatrist, please see a therapist, because
34:10
it's, again, a holistic approach, right? And
34:13
this is what I try to tell my patients and my
34:15
other colleagues, doctors, and specialists. Please
34:18
look at the patient in a holistic way, head to
34:20
toes, inside out. Let's not have a tunnel vision
34:24
when we treat patients, because we have to think
34:26
of everything. We have to think about how the
34:29
past trauma affected her current anxiety, her
34:33
depression. And now we're adding another layer,
34:36
unfortunately, which is perimenopause. It can
34:38
also make our anxiety and depression and the
34:41
PMS worse. So let's look at everything together
34:45
and not just like, oh, this is just your anxiety,
34:47
or like you said in a bit, Susan, like, you're
34:50
just going through a lot, you have three kids.
34:54
No, it's not that. I mean, you've always had
34:56
the three kids, but what happened now? What changed
34:59
now? The stress is always going to be there,
35:02
but why am I not handling that stress or this
35:05
extra burden like I used to do that before? So
35:10
yes, please talk to all the specialists. And
35:12
I try to include my PCP in the game, the psychiatrist,
35:18
the therapist, because we are all going to be
35:20
there to get better care to the patient. We work
35:24
all together. It's not just me or the gynecologist
35:28
or just the therapist or the psychiatrist. And
35:31
really quickly, because this conversation, I'm
35:34
so glad we're going to meet monthly because we
35:38
had like three questions and we have like 16
35:41
others on our list. But is there an upside to
35:46
perimenopause and menopause because it sounds
35:48
like a lot of overwhelming details and life changes
35:53
and at least in adolescence, you get to grow
35:58
up and be an adult and do all these things. What's
36:02
the upside here? You're very right, Susan, because
36:07
I hope we didn't depress the audience here. But
36:12
yes, perimenopause, please don't think of it
36:15
like, oh my god, I am going to start taking estrogen
36:19
now because I never want to go into perimenopause.
36:22
So think of perimenopause like a new chapter
36:24
in your life. Let's not think of it as the end
36:29
of our like menstruation or things are going
36:33
downhill after the impediment of pause. So let's
36:38
think of it as a new chapter. And these days,
36:42
women are so empowered, you can write your own
36:44
chapters. So let's not just go through it and
36:49
we're depressed, we're not happy. Go through
36:52
it, ask questions, have those open conversations,
36:56
start early. prevention is better than cure,
36:59
right? And just write your own perimenopause.
37:03
It can be actually one of the best years of your
37:06
life because if anything A lot of time, I tell
37:09
patients, have it be like a wake -up call that
37:11
I want to take control over my health, and I
37:15
want to empower my body and my health. So if
37:18
anything, a lot of patients start taking the
37:21
right supplement at that time, start exercising,
37:24
seeing their specialists and their doctors. So
37:27
if anything, don't think of it as, oh my god,
37:30
I am never going to age in my life. It's OK.
37:34
It's a natural phase. Everyone will go through
37:36
it. But you can get to choose how to go through
37:40
it. If anything, now with those conversations
37:42
that we're having, and luckily we have a lot
37:45
of social media out there that are actually talking
37:49
about it, and even like resources for patients,
37:51
books for patients, right? That can help patients
37:54
understand what is perimenopause. So it's not
37:57
as bad as what we think it is. Right, and you
38:02
can talk to your doctors, you can get some help,
38:05
and it exists, and we're gonna have to go through
38:08
with it. I think the upside, I just kept thinking,
38:11
well, I'm not gonna have a monthly period. That's
38:13
great, right? I don't have to go to the grocery
38:16
store and always stock up on tampons and pads,
38:20
and sounds like a positive to me. I love it,
38:24
Susan. Yes, we always have to think positive.
38:26
Right, because it can be a long duration and
38:29
we're all going to have to go through it. And
38:32
I think one of the things that I found really
38:34
helpful is being able to talk about it. Right?
38:38
Like, just saying, these are the things. It's
38:40
weird, and it shouldn't be weird, and we should
38:43
openly discuss it with, you know, our doctors,
38:46
our friends, our family members, and our loved
38:48
ones. I feel like everyone's ready for puberty,
38:52
because we do talk about it in the girls' locker
38:54
rooms, but no one wants to talk about perimenopause.
38:57
Like, no, please, let's talk about it. Do not
38:59
be afraid. If anything, a lot of patients are
39:02
so happy that they get to see me, because they're
39:06
friends told them like oh my god I started this
39:08
and like this is the best thing ever that happened
39:10
for the last few months because I've been suffering
39:13
and it's a domino effect right so this is how
39:15
patients can like talk to each other it's okay
39:18
now obviously there's a lot of misinformation
39:20
there so I just want to put that out there so
39:23
please talk to specials that are certified in
39:26
perimenopause it's good to talk to your girlfriends
39:29
about it obviously but also there are some specialists
39:33
or some providers that might not be as specialized,
39:38
so just be careful. So please pick your doctors
39:41
wisely, so you can get the right treatments.
39:45
Well, right, as you were saying, you have to
39:46
have specialty training to have this field of
39:51
expertise, because the medical schools are not
39:53
teaching it as much as what you were saying,
39:55
right? Unfortunately, yes. Right, okay. So, I
39:57
mean... Start with your primary care physician
40:00
and then kind of move on and find specialists
40:02
and if your girlfriends are talking about it
40:05
Maybe they can refer you to someone or or you
40:07
know reach out and and do all that. All right
40:10
Dr. Nadine Hamoud, what an amazing conversation.
40:13
Thank you so much for taking the time to talk
40:16
to us about it helping us stay informed and I
40:19
look forward to our next conversation we're gonna
40:22
have to Focus in on like a specific topic because
40:25
it's so It is it is an Olympic sized pool that
40:30
we're gonna have to navigate But we will do it
40:33
and I'm so happy to be here. Thank you again,
40:36
Susan And you know, I hope the audience thought
40:39
that this was helpful again, please talk to your
40:42
doctors You don't have to suffer in silence You
40:45
don't have to suck it up and hey, it will just
40:47
be a phase and it will go away Talk to your friends
40:51
talk to your doctors about it and don't be ashamed
40:54
of it. All right. Well, thank you so much