Latest / Coffee Playdate Podcast with Dr. Olga Deengar / Your Symptoms Are Real and You’re Not Crazy Ep 44: Dr. Boram Han on Menopause Care
Transcript
- Dr. Olga Deengar: Welcome to the Coffee Playdate Podcast. I'm your host, Dr. Olga Deengar, and today I have a very special guest who is coming back to our podcast, Dr. Boram Han. Welcome! Boram Han, MD: Hi Olga. Thanks for having me. Dr. Olga Deengar: It's great to have you back, and we have a special episode today which we'll get into. But first, Boram, remind me, how do you like your coffee? Boram Han, MD: I like my coffee always as a latte. Dr. Olga Deengar: Yay! Lattes are some of my favorites as well, but I'm a cappuccino girl. Boram Han, MD: Yeah. But I think the point is like we have to have some of milk or something in it to make it a little bit more creamier. So yeah, I think that's a yeah. Rather than I know a lot there's a lot of black coffee people out there, but I'm a latte or a cappuccino, like some milk to make it creamier. Dr. Olga Deengar: Yes, I love that. All right, Boram, we are gonna start off with our first game. That's the Rapid Fires questions game. You know the drill. I'm gonna give you two answers. You choose the one that you like most. Don't have to explain your answer or why you chose it. Here we go. First question: morning sunlight or an afternoon walk? Boram Han, MD: Morning sunlight Dr. Olga Deengar: Very good. Next one is tracking symptoms in an app or keeping a simple paper journal. Boram Han, MD: Keeping a simple paper journal, definitely. Dr. Olga Deengar: All right, very good. How about this one? A cooling pillow or a bedside fan? Boram Han, MD: bedside fan. Dr. Olga Deengar: Awesome. And the last question here, sleep disruption or brain fog. Which symptom do patients underestimate more? Boram Han, MD: That's a hard one. Yes, I would say both and I would just to add an explanation a sleep issue comes up more often, but brain fog people get more alarmed. Dr. Olga Deengar: Yeah, that's good. Okay. The next game is take a sip. It's the same concept, but here we both answer and if our answers match, we take a sip from our coffee cups. Boram Han, MD: Okay, sounds good. Dr. Olga Deengar: First question dark chocolate or salty popcorn? Boram Han, MD: Dark chocolate. Dr. Olga Deengar: Dark chocolate. That's what I was into. Boram Han, MD: Dark chocolate dark chocolate. I thought we had to say it at the same time. Dr. Olga Deengar: No. You can say it first and then I'll follow with my answer. next question, Pilates or lifting weights? Boram Han, MD: Lifting weights. Dr. Olga Deengar: Lifting weights, me too. Cheers. Boram Han, MD: Cheers Dr. Olga Deengar: Next question, a great night's sleep or an extra hour in the day? Boram Han, MD: Good sleep. Dr. Olga Deengar: Yes, me too. That's so important. Cheers Boram Han, MD: Mm-hmm. Dr. Olga Deengar: again. Boram Han, MD: My goodness, three in a row. Dr. Olga Deengar: And the last question here, one powerful health habit done consistently or a complete wellness overhaul? Boram Han, MD: Definitely one consistent change is for a long term. Dr. Olga Deengar: Yes, me too. One consistent habit. Cheers to that. that was four in a row, Amazing. For those of you who are listening, our guest today is Dr. Boram Han, a very good friend of mine, She's also a double certified physician in internal medicine and obesity medicine and a menopause society certified practitioner who's practicing in Boston, Massachusetts. For more than 10 years, she's helped women navigate some of the most misunderstood chapters of their health. And today she specializes in menopause and obesity care. So she's really truly deeply active across this space. She's teaching physicians and residency programs how to prescribe menopausal hormone therapy, and she's contributing to the anthology Women for Women, where she wrote about weight gain in midlife. She also founded Hormone Lab, which is a menopause. Book club for Korean American women building community around menopause education. And she is currently building a private practice in the Boston area focused on menopause and obesity care. I am so excited to welcome back Dr. Boram Han to the Coffee Plated podcast. Woo! Boram Han, MD: Yay. Thank you so much for having me and thanks for the great introduction. Dr. Olga Deengar: Boram, what what are you not doing? I mean, you are so accomplished and you're building these incredible things. You're contributing to your community. I mean, I I love everything that you're building. Boram Han, MD: Thank you. I mean, I think I think if it's naturally something that you really enjoy doing, it's just you know, you keep on doing. It's a lot of work, but at the same time you really enjoy it and the energy comes with it. Dr. Olga Deengar: Yes. well said. So speaking of your passion, what made menopause care feel like your calling? Boram Han, MD: I think it started with me aging with my patients. Patients started coming to me with all these menopausal symptoms and they started asking for menopausal hormonal therapy. And I realized my patients were really struggling. They had so many symptoms coming all at once to them. And they just had so much difficulty navigating it. And it was really hard to get treatment because you know, as a primary care physician, I noticed that it was really limited and not many providers, including physicians, felt comfortable prescribing it. And for physicians to find someone that would be prescribing menopausal hormonal therapy and getting the right treatment, there was some real access gap and that gap was real. So I'm an internal medicine physician and also board certified in obesity medicine but I decided to pursue a menopause society certification and I really noticed that those areas all sort of like overlapped and I thought that would really strengthen my perspective and my expertise so that I can help my patients more. So, you know, and also a big thing is that Noticing what my mother's generation went through. Because our mother's generation that was a generation that menopausal hormonal therapy was totally halted. And during the past two decades, menopause was not discussed and treatment was not given to the patients. So our mother's generation were not able to get the treatment at all because of the halt of the prescription due to fear and misconception. That truly makes me so sad. And that's what really motivates me with this work. I really don't want this generation of women to go through that. And I want them to have the opportunity to get that treatment. So that's why I do this work. Dr. Olga Deengar: That's amazing. You have a big mission, and I really love how you're trying to integrate all of the different components of health, not just menopause, but also obesity care and your primary care knowledge all into one to really bring the most value to your patients. Now, Boram Han, MD: Thank you. Dr. Olga Deengar: a lot of people use the term perimenopause and menopause interchangeably. can you walk us through what's actually happening in the body at each stage? Boram Han, MD: Yes, definitely. So menopause, perimenopause, those are many times used interchangeably, and many times they're really confused. The thing is that there are different stages and perimenopause is the transition and it starts with our fluctuating hormone levels and when we start noticing the menopausal symptoms. And it can last several years. It depends on each patient. Everyone is different, Menopause is a certain time of period when which is 12 months from the last menstrual period. And the time after that is called postmenopause. So that period postmenopause is a period once. our body have sort of settled down from the chaotic hormonal changes into a new, somewhat stable state. So timing matters because that also helps with deciding on treatment. So knowing your stage where you are really helps you, us women and also the physician. helping you try to understand what's going through your body and also trying to decide on the management. Dr. Olga Deengar: Yeah, there are a lot of different hormone fluctuations, and some of them are more exaggerated at specific stages depending where you're at. So it is really important to distinguish between those different stages. Amazing. Boram Han, MD: Yes. Dr. Olga Deengar: Now, even for physicians who specialize in this, why is it so common for them to miss or downplay their own menopausal symptoms. Boram Han, MD: So, Olga, I'm pretty sure you notice this, but physicians are trained to prioritize other people's health before their own health. And menopause Dr. Olga Deengar: Yes. Boram Han, MD: symptoms sort of get mixed into that pattern. We have many women, physicians, we struggle with many symptoms of hormone changes like brain fogs, sleep issues, mood changes, and worsening anxiety. And many times we downplay it and say, it's because we're burnt out, or it's because of our hectic schedule. And also, you know, somehow, surprisingly, many of us are reluctant to bring this up to our own physicians because we think that being trained in medicine somehow means that we have to know it all, and we feel somewhat ashamed and reluctant to bring it up. But The thing is that because the as I told you before, there is a real training gap in this area. And menopause was not taught, unfortunately, during the past several decades. It was not taught during medical school and also during residency. So there is a real knowledge gap in here. So many of the women physicians are going through that menopausal stage, or many physicians here in the audience will face that in the future. Trying to learn that and learning being informed will really make a huge impact down the road for your own health and also helping the people around you. So I think knowing about the knowledge. And actually living through it is two different things. So that's why I tell my women physician friends that you deserve the same standard of care that you provide to your patients every day. Dr. Olga Deengar: Yes, it's true. Doctors are the worst patients because we always kind of put our own health on the back burner. We're like, it's nothing. I'm not gonna worry about it too much. But then these symptoms build up and they get worse and they go untreated. And it you can't live life like that. You really truly have to take care of your own health just as much as taking care of your patients. I'm a strong believer in that. Boram Han, MD: Totally agree. Dr. Olga Deengar: So everyone knows about hot flashes and night sweats, but what do you think are some of the quieter symptoms that don't get talked about as much? Boram Han, MD: Yes. So hot flashes and night sweats you know, they're really obvious. But there are many other symptoms that are overlooked. Some examples are joint pain. Many of course you may have some underlying joint issues that are contributing to it. We have to look at that as well. But there is a significant hormonal component in it in midlife women because your body aches all over. If you don't think about that, many times we're just digging through other stuff when I actually, you know, some hormonal component having that aspect will be really helpful. The other things are like brain fog, memory issues, those are really significant ones women really worry about. And of course, we have to do the evaluations for it to make sure there's no other neurocognitive issues. But having that aspect because there are many, estrogen receptors in the brain as well, knowing that hormone can have an impact on that changes the care as well. Also, other stuff are, you know, mood changes, you know, anxiety, those get blamed totally on just stress and life circumstances. Which is, I admit, it's very, very important to address those issues. But having that insight as well, it may be, you know, the women's hormonal changes giving an impact. That is also really helpful to know as well. The important thing is I think these symptoms develop slowly and it takes years. without actually being able to connect the dots together as a big picture. So that's something very important for us to remember. Dr. Olga Deengar: Yeah. It's true. I mean, these symptoms, the hot flashes and night sweats, they are so uncomfortable. And I think that's why women reach out to their doctors right away when they experience that. But like you mentioned, the brain fog and some of the other quieter symptoms continue to linger. And that becomes a problem, especially when you're not putting your health first and you're not prioritizing yourself. Boram Han, MD: Yes. Dr. Olga Deengar: So let's talk a little bit about hormone therapy. it's such a ha it has such a complicated reputation. But can you tell us where that comes from and how we got here? Boram Han, MD: So the bad rep about hormonal therapy started in the early 2000s. a study which came out at that time called WHI study. It was misinterpreted at that time. And that scared everyone away from menopausal hormonal therapy. So for all the patients and physicians and everything halted. And it's been two decades. And during that time, No one taught about it and no one prescribed it. And everyone was just recommending no, it's not safe. The thing is that now newer research are coming out, more nuanced research is coming out and trying to rediscover that for in certain populations. It may be actually helpful for to treat these patients. And you know, but the thing is that our old fear is really embedded in us, and that's why so education is key because hesitation and fear is really hard to break, and that's why ongoing learning to move past beyond that is so important. Dr. Olga Deengar: Yes, we always have to look at the latest literature and make sure that we're reviewing it thoroughly and we're not just jumping to conclusions which could lead to misinterpretation. So I'm glad that this area is is evolving a lot more. Good. And what does the current research actually say now? Boram Han, MD: so research is now definitely much more reassuring than what we saw in the past. So the general recommendation is that women who are healthy and closer to your menopause, generally speaking, approximately 10 years from your last menstrual period, and also generally under 60 years old, it says that it will help your symptoms. And it has a significant benefit in your cardiometabolic health and bone health. So the original study, which came out in 2000, the study population was totally different. The age that they studied and initiated the treatment their average age was mid-60s. And also the formulation of the medication that they study is totally different from what we're prescribing these days. So of course, everyone's situation is different. We do have to know that. But the thing is, it's not a blanket yes, that everyone should get it, but the conversation should start early on, trying to speak with your doctor. Is this a good option for me? But that has to start from. you know, current evidence, not out of the past fear. Dr. Olga Deengar: Hmm, yes, that's very true. And so for women listening who are kinda on the fence or unsure about hormone therapy, what's the one thing you'd want them to know? Boram Han, MD: the most important thing is to actually have that conversation. And you have to bring it up because if you don't bring it up, probably the conversation won't come up. And to actually seek a physician or someone who has real expertise in that area, in that space will make it easier for you. The thing is, having that conversation earlier on is so important and the changes that you make earlier on in your health will make impacts down the road. And also, if you seek physicians who took the time to study and research this area, are more knowledgeable in this space. They're more comfortable prescribing it more thoughtfully, meaning they will be able to explain to you what the benefits are, what the risks are. There were able to balance those out and really have those conversations. Many formulations exist. And I'm just saying that one might not work for you. There are many other formulations that might actually work for you. So Having that knowledge of different you know, nuanced care, that's really important. the goal is actually sitting down, making a conversation with someone who is knowledgeable and discuss if this is a good option for you. Dr. Olga Deengar: Yeah, definitely. The conversation is definitely the first place to start. I a hundred percent agree with that. If you think about it, when you go and see your physician, they have a million other things that they're thinking about and they may not know if you're close to perimenopause or or having menopausal symptoms depending on your follow-ups and all of that. So it's not at the very forefront of their mind. So if you start the conversation, then they'll be able to really Look at what you're experiencing and treat those symptoms accordingly. So I think that's very important, like you said. Good. So let's switch gears a little bit to weight management. Now, since this is something so many women struggle with during menopause, what's actually happening in the body and why do so many people struggle with the weight gain during this time? Boram Han, MD: As you said, in every stage of women's life, many people struggle with this, but during menopause, women struggle even more. This is sad. But it's not just the number on the scale anymore. Now your body feels a little different. Your the clothes that used to fit in on your body feels a little different. So what also used to work in your 20s, in your 30s, start not working for you in your 40s. I want people to know that it's not because you're lazy. It's not because you're not trying. It's actually there are some hormonal changes in your body that's making it difficult for you. the main driving factor in this is your declining estrogen. the estrogen decline actually shifts your body fat. what it means is that your body fat shifts from your subcutaneous fat in your hips and thighs to your visceral fat, which is around in your abdomen. We call it belly fat. the visceral fat increases your insulin resistance, And also worsens your cardiometabolic risk. So the thing is, many women start viewing that your body is failing on you, and you're trying to fight against it and blame your body about that. But I want to encourage women that your body is going through a change, you have to embrace it and have some grace And let's try to work with it and understand it and just you know I want women to have that support and have a mind shift. Dr. Olga Deengar: Yes, that's exactly right. I'm totally with you, Boram. It's so important for us to realize what's happening in our body and really do something about it or try to to change things for the better. Yeah. So knowing all of that, what does actually working with your body look like in practice? Boram Han, MD: so there's so many things we can do in this area, So I would say first of all, strength training. Our muscle mass is so important. As we build up our muscle mass, it will improve our insulin sensitivity and increase our bone health, and it will prevent osteopenia, osteoporosis down the road as well. So it's extremely important. The second thing we need more protein intake. our body goes through a process called anabolic resistance, Let me explain to you a little bit easier. Protein. Muscle protein synthesis is a process in our body that we try to build muscles with from the protein that we have in our body. But as we get older, our body systems get a little less efficient. Meaning, With the same protein that we take and consume, we're not able to build the same amount of muscle in our body. So it becomes less efficient. so in order to maintain the same muscle, we actually need more intake of the protein. We have to know that, and that's why you know more protein intake is extremely important. The third thing is I would say sleep and stress management. And many women physicians really have difficulty in this area. And if those get disrupted, our cortisol level increases. And also the big thing is that our body leptin and ghrelin hormone, which are hormones that regulate our appetite and satiety, those get imbalanced. And because of that, our weight changes and keep we have difficulty losing weight in that stage. last of all, most important thing is we need patience. Because results are much slower in this stage. Things don't happen overnight. as we had the questions early on, Olga asked me, like building one small habit change that will sustain for years is more important than trying to make a drastic change that's gonna only last for two weeks or so. Dr. Olga Deengar: Yes. absolutely. And those are really great tips that you've hit on because without the sleep, without the weight training, without taking care of your physical, emotional, mental health, I mean, it's gonna be really tough for you to get through any stage of your life, not just in menopause and perimenopause, but it it is really I'm I'm a firm believer that you need to start off your days in the best state possible. Be the most energized that you can be, because everything you do after that, it'll help you get through it much more creatively, with a lot more energy, with more clarity. And that's really the key here is to live life from a place of alignment and fulfillment. So I'm I'm really excited that we're having this conversation, Boram. This is so important for all women to hear, you know. Boram Han, MD: And I do think you're big giving a big impact with this platform too. Dr. Olga Deengar: Thank you, Boram Now, looking back at your own training, is there anything about how physicians are taught that you wish had been different when it comes to menopause? Boram Han, MD: Yes, definitely, I would say. as I told you, because menopause education was halted for decades. the surprising thing is the average women, one third of their life is spent in postmenopause. Considering Dr. Olga Deengar: Wow. Boram Han, MD: that And the amount of of education that we have on that stage that women are spending, that discrepancy is huge. And that lack of foundational education, it's really important for us to address because otherwise these conversations will not come up among our conversations with our patients. And even though it is brought up, we won't feel comfortable. you know addressing this and trying to guide patients in it. So many of the physicians or providers in this area, their knowledge is self-taught after training. I really think it's important that it should be embedded in our education. For example, medical schools needs to start having talks and modules about menopause and also residency training, especially in those specialty that are gonna be involved in this care, such as OBGYN, internal medicine, family medicine. I do think that having that education in their training is important. And that's why I go to residencies programs to give Talks and how to prescribe menopausal hormonal therapy because you know having that creates less barriers for physicians to prescribe these for patients who are seeking for it. and more physicians should feel comfortable engaging in menopause care. Dr. Olga Deengar: Yes, and I'm so excited about you sharing your knowledge and expertise with the residents who are learning, who do need this to fill this gap because there truly is not enough knowledge or education that's brought into the residency curriculums and the medical school curriculums. I honestly don't even remember if we had like more than one lecture on menopause. And it is such a huge part of women's lives. So I'm I'm really happy that you're sharing your knowledge and and bringing that value to everyone. Boram Han, MD: Thank you. Dr. Olga Deengar: Now as we start to wrap up, if you could leave every woman listening with one piece of advice, what would it be? Boram Han, MD: I want women to know your symptoms are real and you're not crazy. Many people just come with me and say, people think I'm crazy. No, you're not crazy. And your symptoms are real. but you shouldn't be struggling with your symptoms silently. And there are real tangible ways that you can ask for help, but you just have to know that. And reach out to your primary care physicians and you know doctors And ask for them to help you with that. And also if your doctor does not feel comfortable prescribing it, that's totally fine. the doctor will help you guide you to the direction who or refer you to someone that will feel comfortable having that conversation for example, for a menopause society, they have a directory of doctors and providers Who have the certification in menopause. that's how a lot of patients come to us. because they know that those physicians and providers took the time to get their education more in depth in that area. So seeking for those people maybe actually, make your journey a little easier regardless of the outcome, actually having that conversation is a first start and most important. if any of these resonates with you, as Olga mentioned previously, I do a lot of work in this space for example, I am participating in a anthology book with other women physicians Who are in this space in taking care of women hormonal health, I wrote a chapter about midlife weight. Why is it so difficult for people to lose weight in this stage? So, if you would like to get some perspective on what women physicians would like patients to know, please follow along. And also, I am doing a menopause book club for Korean American women in the United States. It has been amazing to create a community around reading books together. And I think that brings so much knowledge to patient because many of these women are actually investing their time and energy to Dr. Olga Deengar: Yeah. Boram Han, MD: gain knowledge in it and the response has been amazing people sharing knowledge asking questions also you know I am building a private practice in the Boston, Massachusetts area focused on obesity medicine and menopause care. So if you're in the Massachusetts area, I'll be happy to help you with that. So reach out to me, I'm also active on social media, my social media handle on Instagram is Boramhan MD. B-O-R-A-M-H-A-N-M-D. And I love talking about this to many women, so please feel free to follow along and ask me questions. Dr. Olga Deengar: Yes, absolutely. Reach out to Boram Han She is incredible. thank you for sharing all of your social media and and ways that our audience can reach you because I think working with you is amazing. I mean, you are so knowledgeable, you've studied, you've you've had like a million board certifications. You're always looking for ways to expand and grow that knowledge, and not every physician has that same drive. So I think this is really unique to you, Boram. I encourage everybody to reach out to Boram. Now before we let you go, is there any resource you'd like to point our audience to if they want to keep learning? Boram Han, MD: Yeah, I built a free guide for your audience, Olga, it's called 10 Questions Every Woman Should Ask Her Doctor about Menopause and Perimenopause. it will help people to be a little bit feel more comfortable actually bringing these in questions to your doctor. I will make sure Olga has the link to it in your show notes and so that our listeners can access that and download it. Dr. Olga Deengar: Absolutely. Thank you so much, Boram. That's very generous of you. We'll definitely include the link in our show notes and I'm excited to check it out as well. I'm always open to learning new things and really helping expand my knowledge as well. Boram Han, MD: Yeah. Dr. Olga Deengar: So, Boram, thank you so much for joining us again on the Coffee Plated podcast. I'm excited to share this episode with everybody and it's been an honor and a privilege speaking with you. I hope you have a great day. Boram Han, MD: Thank you so much, Olga. I'm excited for the work that you're doing and thank you so much for having me.