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Menopause Symptoms Doctors Miss: Dr. Jennifer Schroeder on What Your Body Is Actually Telling You · A Lifetime to Learn

• Dr. Jennifer Schroeder (00:00.076) It's no longer a paternalistic model of care where you tell me symptoms and I tell you what you should do. It's shared decision making about how are you, how bad are your symptoms, and understanding how to fit that together and have a true conversation with somebody. Leslie Zanoff (00:22.67) This is a space where presence meets purpose, where we explore the moments that shape us, from entrepreneurs and change makers to women in leadership. It's about learning out loud, together, with honesty and humor. Where luminaries with real stories remind us how to live by our own rules. Because progress doesn't come from having all the answers, it comes from staying open. And we've got a lifetime to learn. I'm your host, Leslie Zanoff. Let's get started. Hey, Dr. Jennifer Schrader has spent 25 years in medicine, delivering babies in Panama, investigating outbreaks for the CDC, teaching the next generation of physicians, and raising three daughters. Then she did something that a lot of doctors never do. She walked away from a conventional practice to build something entirely her own. After a life-changing leg amputation in 2020, Anna returned to cycling. She founded Embrace Family Medicine and One Self-Health in Bentonville, Arkansas, a specialized care model built specifically for girls and women across every phase of life. Dr. Schrader, welcome to a lifetime to learn. Great. Okay, I just after an introduction like that, I want to talk about your leg amputation and starting a business in the same year. Is that the way it went? Dr. Jennifer Schroeder (01:35.019) It's great to be here. Dr. Jennifer Schroeder (01:45.752) That is the way it went. Okay. that was preceded by raising girls on my own for three years. Okay. while still practicing full time and and doing deliveries. And I got remarried. And that was actually the crux of what led to other things. interestingly, because of health insurance. my husband had good health insurance. I had good health insurance. So we compared. Leslie Zanoff (02:08.782) Okay. Dr. Jennifer Schroeder (02:15.39) And being in healthcare mine was not the better of the two. Wow. And it allowed me to look at other options for practicing and a business model that would not have been an option for me otherwise. So Leslie Zanoff (02:32.014) Okay. Just a call I mean, that is a lot happening. Dr. Jennifer Schroeder (02:34.286) Yes. We had we had a a wild first year or two, so absolutely. Leslie Zanoff (02:38.657) Okay. Okay, well I know that you know when a woman comes to you and says, I just don't feel like myself 'cause you probably hear that a lot. I mean, where where do you even begin with that, Doctor Schreider? Dr. Jennifer Schroeder (02:52.536) I think the first place is validation. I think it is so common right now and something that expresses what seems intangible and ever changing, hard to describe. And I think the first thing is validation. doctor's appointments are too fast and trying to wrap up in a in one nugget to be able to express as somebody I'm not okay right is I don't feel like myself. And some physicians hear that, some don't hear that. And so my next question is to tell me what you mean by that. Because then it starts to layer out all the other things I want to know to help me figure out how much of it maybe hormones, how much of it has to do with other life stress, so that I can piece together what we need to do next. Leslie Zanoff (03:51.882) Okay. And now and when you say hormones and then the different life phases, it made me think too, since you're focusing on women and girls, is there a certain age that patients come to you at? Or Dr. Jennifer Schroeder (04:04.622) I've seen people all through the ages. and so when I had to think about where do you really start? Because the idea for being sort of primary care, but really specially care for for women and girls had to do with my own menopause journey and figuring that out in the midst of practice and everything else. And understanding what women need at that juncture. made it easier to look back in time at what happened with contraception, what happened with pregnancy. And some of the same struggles carry through and some of the same hormonal issues sometimes underlie things that have happened since we started having periods. Right. And even before you have a period, you start to have changes in your body that will shift mood or will shift acne. will shift other things in your body. And so it was really thinking back to how far back do I need to go so that if a girl is struggling, she has someone she can go to. Leslie Zanoff (05:11.33) Right. Okay, I love that. And I just wanna point out, because you're in an interesting your practice is interesting because you are an OBGYN but also family practice. So that's a little bit broader scope. You don't always see that. Dr. Jennifer Schroeder (05:26.798) It's less common. when I went to medical school, it was in that time period there was a big push for primary care. Okay. And how important that was for patients. I understood that very well, having grown up into a rural community and seeing my family practitioner go in and out of retirement three times until they could get someone who was gonna stay in that rural community. And at some point, how far people had to go to do a delivery. or to go to a doctor's appointment. And so the pathway that made sense for me at the time had to do with being able to provide a broad range of care to a lot of people. I knew I would always have a job. Yes. And after I did my family medicine residency of three years, I did a OB fellowship, surgical fellowship for a year. Okay. So that I knew it was broader and I could take care of women no matter what happened. that's how I ended up In that juncture. Leslie Zanoff (06:26.584) Okay. Do you think is there one women's health issue that you think is dramatically underdiagnosed or maybe dismissed, if there's something you see regularly that isn't getting the attention it deserves? Dr. Jennifer Schroeder (06:42.242) I think absolutely menopause by far. it is one of the things that requires some time. It is not a diagnosis made by lab values. Many years of symptoms can happen before you can quote unquote diagnose it another way. and right now medicine does not reimburse people for time in a way that Leslie Zanoff (06:45.869) Okay. Dr. Jennifer Schroeder (07:12.17) is from a business standpoint functional. Leslie Zanoff (07:16.565) Yeah. So I mean for Dr. Jennifer Schroeder (07:18.274) The talk there is about menopause. We hear lots about it. On the ground, when you talk to women who walk into my office, they still have experiences where someone shrugs their shoulders and says that's menopause and walks out the door as though there are no options. Right. they say their labs are normal and they walk out the door. And so it takes a certain amount of energy and tolerance to continue to look for someone. Leslie Zanoff (07:20.225) Okay. Dr. Jennifer Schroeder (07:47.906) Who hears you? And I think the women's health initiative study and the interpretation of it 20 years ago led us down a pathway that was very hard to come back from. Some of us have been working on it for years now. Right. it is not spread over into the rest of the mainstream of family medicine, OBGN, internal medicine. much less do the rest of the specialists really have it always on their radar. Some do and some don't. but so many things are missed because it affects so many systems in your body that as a specialist, we often dial into what does this person's problem fit into best in my specialty? And they don't think about the bigger picture. And that's what gets missed sometimes when you don't have a primary person who has time to hear your story. about what's really going on. Leslie Zanoff (08:48.76) Okay, well right. And I've experienced that myself in seeing other physicians and not necessarily connecting the dots back to hormones, whether it was my eyes, my teeth, and and having other physicians say maybe, Well, aren't you too young for this phase of life? Not understanding, you know, where women are on their journey. So Dr. Jennifer Schroeder (09:11.886) The aren't you too young for this? we would all love to be too young, right? But average age of menopause is 51, 52 in the United States. Women can have symptoms up to 10 years prior to that time period. African American women, Hispanic women can have longer transition time of symptoms. Asian women tend to have a shorter time period, but everybody's an individual. Leslie Zanoff (09:24.128) Okay. Dr. Jennifer Schroeder (09:40.64) in what their experience is like. Some women don't have hot flashes. They might wake up at night and not understand why they're waking up. And if you don't make that connection and think about it based on their age, you might not put it together. If you don't ask them when women in their family go through menopause, sometimes that clues you in that this is somebody who's going to go earlier. Right. If it's on your radar. there are there are ways to sort through it with people. but it takes some effort and and In defense of docs, I think genuinely people go into that profession because they care. Yes. I didn't figure it out until I'd had symptoms for a while because they are in the beginning are so inconsistent, not always in the same system, if you will. it can be hard to figure out even as a patient. Right. So when you start to figure out, hey, something's not right, sometimes you can lead your doc down the right trail. And sometimes you just don't know and you just know something's not right. Leslie Zanoff (10:42.712) Well, and I've heard you talk about it when you hosted your women's conference, that there can be something like sixty three plus symptoms that women experience heading into menopause. Or is that right? Yeah. Dr. Jennifer Schroeder (10:56.28) Yes, it's it's a very long list. Okay. I did not draw the short straw in having the shortest list, which mean was professionally helpful, but you know, not that much fun at the time. but I really think about estrogen is so much the moisture and the lubricant for so many areas of our body. So we get dry eyes, we get dry mouth. We can get a dry throat. We clear our throat. you can get an exacerbation of asthma, dry skin, vaginal dryness, painful sex, change of urination, change of your periods, change of your sleep, change of your temperature. Some women don't have full on hot flashes or night sweats. their baseline temperature just seems higher than it's ever been, and it just kind of stays like that. Leslie Zanoff (11:29.848) Right. Dr. Jennifer Schroeder (11:53.038) on top of all of those things, you may have a lot of symptoms for a few months and then they go away. Right. And they may come back in a week, a month, a year. And that adds complexity. Joints, tendons, muscles, I never want to forget. functionally, what that does to us is very different. your GI tract goes through some change, your endocrine system. Leslie Zanoff (12:04.737) Okay. Dr. Jennifer Schroeder (12:21.29) that includes your thyroid, your insulin level, your glucose regulation is all part of that hormone or endocrine system. And those things interplay with each other. I see lots more women who get diagnosed with thyroid disease when they are starting to get into menopause. because those things affect each other. Leslie Zanoff (12:39.125) Okay. Okay. Well when and then when you said that about your body temperature, is this true? D am I'm am I right? There are times when I get so warm and then it's hard to cool down. It t it seems like it takes longer than maybe it used to. Dr. Jennifer Schroeder (12:59.276) Yeah. Just okay. And, and your temperature tolerance is not as broad as perhaps what it once was. Right. If I thought when I retire I want to be at the beach, now I think, hm, do I want to be at the beach? Right. In the same way. you just don't tolerate things as high, as long, and it takes longer to recover from it. Leslie Zanoff (13:03.149) Yes. Leslie Zanoff (13:20.622) Yeah, my tolerance is less for a lot of things. Dr. Jennifer Schroeder (13:23.074) Yeah. Leslie Zanoff (13:27.498) my gosh. Okay. Well, speaking of hormones that you've mentioned, right, it affects everything from mood to metabolism. Can you maybe this might be too broad of a question, but maybe walk us through of like, what's happening in our twenties and thirties versus through leading up to menopause. Dr. Jennifer Schroeder (13:46.51) So the thing I think about for women in our twenties is you've left the house that you grew up in and you're establishing your adult patterns. You're figuring out who you really want to be friends with in that time period, and you're trying to figure out your career. And so lots of women at that point are trying to learn to self-regulate. Mm-hmm. They want their periods to be even enough. They don't necessarily want to have kids. And if they do want to have kids, they want to figure out the best way to go about doing that and timing. So I think that's a big growth period to figure out what's normal for me and how do I conduct myself as an adult. Right. Leslie Zanoff (14:33.91) Yes, absolutely. Dr. Jennifer Schroeder (14:36.398) Somewhere through our twenties or thirties or later, things start to settle into a little bit better pattern from the standpoint of just life. Because I always think about how does life affect our health? How good a job do we do at taking care of ourselves? And hopefully that gets better year by year. But as we have kids or we have job changes, Or we have relationship changes, that starts to nudge us along as we go. And so I think our 30s can be a very broad range of what's happening at that time. You can absolutely see women in their late 30s who are starting to have perimenopausal symptoms. If a woman goes through menopause, meaning they don't have any vaginal bleeding for 12 months straight. Leslie Zanoff (15:27.488) Okay. Dr. Jennifer Schroeder (15:36.226) That's when you hit menopause. Right. And so you really you're looking back at you and saying, I'm finally there. Well, you know, through that year you're getting close. Mm-hmm. and the years before that, you may have had very scattered periods and you're playing this waiting game to get to that one last one that you'll figure out a year later. Right. if a woman goes through menopause before 45, it's considered early menopause. And that's worth paying attention to because it really helps us hone in on some women who start to have more medical risk factors earlier in life. Their bones thin faster, their lipid profile changes faster, their cardiac risk starts to change, their metabolic risk changes, their chance for obesity or diabetes changes. Okay. And so really dialing in and taking that very seriously, it's a big deal. And and and it can come in a way that sometimes is not recognized until really it's been no period for a year because people think she's too young when she's not. When she needed more attention, not less attention. Leslie Zanoff (16:49.23) Well then when you think about it looking back and you're saying that mid thirties, I know for myself, I'm like, you know, looking back over the last decade, I'm like, those were symptoms of things happening in perimenopause that I didn't even realize that's what it was until having conversations with other women or my doctor. Dr. Jennifer Schroeder (17:09.644) Same thing happened to me. I mean, there were symptoms I had I didn't realize. and 15 years ago, I was terrible at at taking care of menopause patients. There was not as much literature and groundswill of support to go back and do hormones. And it was hard to figure out. There were so many symptoms in so many different areas of the body. I got much better at it when I had enough of my own experience. And I did look back and realize, even as I was studying for the menopause certification test, I was riding my bike around town listening to a podcast. So I could do two things at the same time. Yes. Right? Typical midlife multitasking. And they started to talk about asthma and issues in your respiratory tract. And that's when it clicked in for me. That's the time period when I noticed that I was using an inhaler more often before I get on my bike. And I never put it together until that day. Leslie Zanoff (18:14.422) Okay. Amazing. For me it was itchy ears. And then I remember telling other women and they were like, my gosh, I thought something was wrong with me and I'm like, Yes, I'd like what's happening? No, it's not it's just one of the weird It's one of the things Dr. Jennifer Schroeder (18:29.846) And and so sometimes as we think about it, like there's skin lining the ear canals that gets drier, it gets itchy. huh. It makes sense. But when you have this amalgam of different symptoms, sometimes you can't tell what fits together and what doesn't. Right. And if it's not a life threatening symptom, sometimes we push it to the side and we get through our day and we make dinner and get everybody to bed on time. That's right. And it's not bad to not be overly concerned about ear inching. It's the idea that putting the pieces together is what really helps you take care of yourself and realize where you are. That's on that journey. Leslie Zanoff (19:12.396) Realize where you are. I th that's right. Because you don't I I it took me years to feel like, okay, this is what's happening. Here we go. Dr. Jennifer Schroeder (19:21.132) Yes. And we have enough stress in life that sometimes we think it's stress or lack of sleep. And then at some point we put together will those all go together with us when I don't sleep sleep. When I don't sleep, I'm stressed. And how much is coming from what area? it can be hard to sort out. Right. But absolutely is it doable? One hundred percent. Yes. I think the biggest linchpin. In a woman getting the care she needs is finding a provider who is an advocate for you and is willing to walk on your journey and listen to you and help you. Mm-hmm. Leslie Zanoff (20:04.206) Absolutely. You're you're out there. You just gotta find those physicians. Okay, let's talk about work I I love talking about hormones, probably because that's the journey, you know, th those are the things that I'm talking about myself with my friends. But there's so much noise online about hormonal health right now. The cortisol, your estrogen dominance, do you need to take progesterone? What do you wish More women understood, or what are they getting wrong? Dr. Jennifer Schroeder (20:39.534) I think there is a lot of noise. I think the noise in part was created by the medical profession not hearing us and people looking elsewhere for answers when they did not feel good. And so I think women will research if they don't feel good to try to figure things out. And so I don't blame somebody who's trying to do some of their own research or brings me information and tells me, hey, I think I might have this. Doesn't bother me. I think it becomes a slippery slope sometimes because we live in such a consumer driven culture that sometimes information is very linked into a purchase. And that's where it starts to get a little dicey sometimes. I want you to have care. I want you to be able to get what you need. And it's complicated sometimes to be able to navigate that. And so where is the line for I can't get this consistently for my patients, so I'm gonna figure out a way to provide it? I understand that. Mm-hmm. Because we don't want people to not have care. However You do have to be prudent about what makes sense. And is this someone who is giving advice that has the knowledge and experience background to give that advice? Or is it the experience that they've had, experience of 10 of themselves and their nine friends? Right. Okay. And and because that sometimes is it's hard to not be influenced by the health of the people around you. it makes you more aware of things that maybe were not on your radar. And so sometimes the personal experience you have can leave you down lead you down a pathway that is not replicated in research. Right. Because it's the study of who do I know? Rather than what is what do big research studies tell us. Right. And that's part of the juncture we're in now. Dr. Jennifer Schroeder (22:59.042) We want to provide evidence-based medicine, but literally we don't have enough studies. We don't have enough women in those studies. We don't have enough people of color in those studies. And it skews the data a little bit. Mm-hmm. it doesn't provide us as much scientific Steadiness on the ground to feel like I can confidently recommend this to somebody. And so I think the idea that we do evidenced informed care. This is as much information as we have. I don't think this is going to do harm. And I disclose to my patients, this is what I think will be helpful to you. There's not as much research as I like, but I've had good success with it. I'm very honest with patients about where I think it fits on that spectrum. because I'm not always right. And I try to balance that risk of benefit, risk, potential harm. And I don't give my patients things I would not take. Leslie Zanoff (24:04.862) Right, but I think that starts with the validation, like you're saying, being validated and then being a physician where it's do no harm, but also I'm educating you to let you know this is what I still think would be best. That's important. Dr. Jennifer Schroeder (24:22.136) Yes. And I think it's no longer a paternalistic model of care where you tell me symptoms and I tell you what you should do. It's shared decision making about how are you, how bad are your symptoms, and understanding how to fit that together and have a true conversation with somebody. Because we have women now who have higher risk of breast cancer. Or they may have a higher risk of cardiovascular disease. I do as much investigation for them as I can so that I know their risk before I may go down the hormone road with them, depending on how much they want to know. Right. But I give them information to put decision making in their hands and have a conversation to try to sort that out. because it doesn't mean they can't take hormones. If you can't move your shoulder because you have a frozen shoulder. That's that's not living life. Right. If you've done all the things to try to rehab that, at some point it's her life. It's not my life. She has to live her life day to day. And so that's what shared dis decision making is about. Right. Leslie Zanoff (25:35.95) Which is so great that we're at that point too. I feel like when I have conversations even with my mom, you know, she's like, Well, we just didn't ask those things. We didn't know, we didn't know enough, we didn't ask those things, and probably might have thought, I'm not allowed to ask that of our physician, or this person knows more than me. And so it is. I I appreciate you saying that. It is a shared decision. Dr. Jennifer Schroeder (26:02.254) Absolutely. And it should be. Our our mothers were still in the generation that they couldn't go to the bank and get their own checking account and their own credit card. Right. So to tell that group of women what you should have advocated for yourself sounds ridiculous. It doesn't it doesn't take into account the context of their life. You're right. And so I think women have grown in a way that has allowed us and To advocate for ourselves in a way that we really needed to, because we're not done yet by far. We have a long way to go. Leslie Zanoff (26:39.852) Okay, I love it. That's great. Okay, just for myself and I feel like other women I've talked to, perimenopause, it seems to catch a lot of women completely off guard. What are maybe some early signs that women should be paying attention to? And why does that go unrecognized for so long? Dr. Jennifer Schroeder (27:01.742) I think early things to pay attention to. if someone is gonna have hot flashes, it is very common that they will start to have hot flashes the week before their period. Okay and then they'll go away. And if they have them in another month and another month, they may start to figure out if there's consistency, but they may not. the majority of women will have some kind of temperature intolerance or hot flashes. And so I think that can be really helpful. If you start to gain weight and nothing else has changed, pay attention to that. Your periods may not have changed yet. They may be ticking right along. And when you check labs in perimenopause, they're gonna be normal. That's and so, you know, the the menopause society recommends that you don't have to check hormones. It's one of those areas that I put it out there. You don't have to check them. I think it's reasonable to check them, and I'm not gonna tell you no. I think we've been held back from getting information sometimes for so long that sometimes they just want information because they feel like there's been a lack of transparency in the past. Okay and lack of shared decision making. So I'll check your hormones. Absolutely. Mm-hmm. Going back to your question. if you start to wake up in the middle of the night for no reason, nothing else has changed, pay attention to that. Mm-hmm. What one of the reasons we are not prepared is it's hard to know when do I talk to this individual person. And it's hard to conceptualize before you start to have symptoms because I don't know for you which symptoms are you gonna have. If you've had migraines, I might tell you, if your migraines start to get into a different pattern, pay attention to that. Mm-hmm. And so sometimes it's a change of pattern. sometimes it's new symptoms and paying attention to where you are in your cycle can help you sort it out. Because menopause is not just going along and falling off the cliff. As your cycle goes up and down with hormones, it goes up and down, you have a period, it goes up and down, I have a period, over time it starts to kind of slowly go down. So there's some place when as the overall trend is going down and you get to that week before your cycle, that little dip sometimes is where you see people start to have symptoms. Leslie Zanoff (29:02.797) Right. Leslie Zanoff (29:25.524) Had physicians too ask me, well, where were you in your cycle? And and you know, 10 years ago, I'm like, well, that's not even something I would know. It's like either you're having your period or you're not. What are you talking about? The luteal phase or you know what I mean? I don't think that's something that enough women know about, myself included, to tell you all the phases. Dr. Jennifer Schroeder (29:49.262) And I I think that's not unreasonable out of all the things that we ask you to do in your life as a responsible adult, to not know what day you're on all the time. Okay. Let's make our best guess. Yeah. Okay. And knowing that if I check your hormones, they're probably gonna be in the normal range makes me fall back to did I have an appropriate and long enough conversation to feel comfortable that that's where this person is? Because it's more a clinical diagnosis early on. Mm-hmm. Leslie Zanoff (30:18.166) Okay. Earlier you mentioned about the data and research in healthcare and how it's not always been done on women, not all races, and maybe not even in in the US. And you've mentioned how African American women may have perimenopause or menopause symptoms for longer than ten years. Can you talk about that? Like are we is the research getting better? Are we getting closer? Dr. Jennifer Schroeder (30:47.598) I think we're doing more research, but do we have equity for the research dollar right now? No, we don't. A friend of mine sent me a study that was published recently about men with prostate cancer who are being trialed on topical estrogen. That study got funded and that study, while important, reflects a percentage of the population. And you can imagine the percentage of women who are in menopause and perimenopause is much greater. The data doesn't match. Mm-hmm. we have a long way to go. And that has to do with Where are women centered at? If they understand their experience, are they the ones who are making decisions about who gets research dollars, about who gets promoted, about who is in academics, about all of those things, about who makes decisions on the federal level about healthcare, about the pharmacy benefit managers that choose whether I can give you on your plan an estrogen patch, estrogen gel. a vaginal estrogen ring, v estrogen spray. There are lots of choices, but sometimes I can't get to those choices. Most of the people are making those decisions are not us. And it shrinks my ability to provide good care for people when I have to spend time on the phone articulating to somebody that you've got a huge whelp. Leslie Zanoff (32:12.64) Okay. Dr. Jennifer Schroeder (32:31.576) From the patch because you have an adhesive allergy. Right. that they would never think about. It just hadn't come up. And so the idea that sometimes things are more complicated is lost. So I think even the idea when I had a conference and I was looking for women to speak at the conference from a variety of specialties, there were some specialties I could not find a woman who was here. Leslie Zanoff (32:46.274) Right. Dr. Jennifer Schroeder (33:00.95) Mm-hmm. And when I looked at other communities of this size in this area to try to find somebody, I could find three or four orthopedic surgeons in a community, or I could find three female cardiologists in another community, but none here. We've not done due diligence for taking care of women in our own community if there are no women in that specialty in Northwest Arkansas. So that's not women are not not good. Leslie Zanoff (33:26.76) my gosh. Dr. Jennifer Schroeder (33:30.24) in that profession or not in that specialty. They're not being recruited here at a high enough number in a circumstance that they want to work in. That's what that tells me. Mm-hmm. Leslie Zanoff (33:41.326) I mean, and how do we and how do we change that? Right? How do you and that's pr Dr. Jennifer Schroeder (33:46.796) A longer conversation. We continue having those conversations. I think we educate our male colleagues. Mm-hmm. There are great orthopedic practices who will ask someone where they're at in their perimenopause or menopause cycle when they come in with shoulder pain. There are other practices or other physicians, it's not on the radar yet. So keep talking about it. Leslie Zanoff (34:09.922) Talking about it. You mentioned earlier about care and it may be attached to a product or something promotion, promotion-wise. That makes me think about social media and all of the supplements. And I love supplements. They've been really helpful to me. But I wonder if there are supplements that we might consider over others. And I I've heard you mention before, too, the importance of. Knowing which ones are fat soluble and which ones are water soluble. Will you kinda just talk about that for a minute? Sure. Dr. Jennifer Schroeder (34:43.054) Sure. I think functional medicine has pushed the envelope farther to make us be more thoughtful about how we care for people and has helped us drill down to levels of science that apply to the individual in ways that we've never had a chance to do before. That's really, I think, where a lot of some of the research about vitamins, supplements, and what makes good sense for us comes from. And so I try to remind people about the B vitamins can be wonderful. They're metabolized and excreted out of the kidney. Okay. And so literally if you take extra, you'll pee it out is a way to think of it. The B vitamins. Yes, because they're water soluble. Mm-hmm. Okay. Leslie Zanoff (35:34.838) Okay. Vadamant. Dr. Jennifer Schroeder (35:40.524) And many other vitamins are water soluble. There are four specific vitamins that are fat soluble that sometimes if you got really high doses, you could get yourself in a pickle and have symptoms from it. A, D, E. And so Are there people who are showing up in ERs because they have a fat-soluble vitamin excess? Not really, but it's something to be aware of. Okay. in the same adage that any other medicine, more is not necessarily better. Right. Okay. So understanding that. but I think that we are getting to a point in medicine. that there are some areas where you can more precisely dial in someone's health according to their genes, if they have MTHFR or one of the genomic SNPs on that. And so if you think about when you're in seventh grade science and they were talking about the DNA helix, and they would unzip it and they would put it back together. Those steps on the ladder are places where we can find gene SNPs that affect how well you absorb, metabolize, and convert, excrete, and utilize basic nutrition. Okay. If those things are not functioning the way they should, sometimes you can fix it not with a medication, but really with the form of vitamin you take or if it's a supplement. And so sometimes my answer really depends on The individual. And that's some of the joy of medicine right now is that you can dial some things in for people very precisely in using genomics, and using some other tests. And the downside of that is sometimes that is not covered by insurance. And it's a hard space to be in because you Leslie Zanoff (37:22.254) Okay. Dr. Jennifer Schroeder (37:49.548) Those things are already out on the market. Leslie Zanoff (37:52.142) Okay, well talk about that a little bit because I know that's something that you have offer in your practice, but it's a new it's it was a newer information to me. Talk about the gene snippets and just maybe let's talk about that a little bit. What it is and just yeah, expand on it. Dr. Jennifer Schroeder (38:06.552) So Dr. Jennifer Schroeder (38:10.142) I ran across a particular genomic test and then did some reading and research. The one I I use is an Intellix DNA. Okay. it's a broad test. You can tailor it to a couple of different areas. I personally landed there because I have two kids who are neurodivergent who were not doing well. And I had sought out help from Therapists, psychiatrists, occupational therapists, bodywork people, for years. And for years, across years. And when I came across this particular test, the first person I did it on was one of my kids. And after everything she had done, she got an IV vitamin infusion and Leslie Zanoff (38:48.576) Okay. Dr. Jennifer Schroeder (39:08.984) She came to me at the age of 17 and said, this made me feel better. Okay. I can tell the difference. So that A, when you're 17, you there's lots you don't notice. Sure. There's a lot happening in life at that point. And the idea that she could tell the difference and articulate that in a way to me was significant. And so it taught me and it started to make sense if some of the people that I see. Leslie Zanoff (39:15.745) Okay. Dr. Jennifer Schroeder (39:39.054) Who may have ADHD or maybe have autism or have depression, anxiety, and some mental health disorders, there's a huge push right now to figure out how much of psychiatric disease and behavioral disorders may have to do with other what we would consider medical things. People don't choose to have schizophrenia. Right. Right? Leslie Zanoff (40:03.64) Yes. Dr. Jennifer Schroeder (40:04.064) There are absolutely genetic factors in some of those things. Some of those genetic factors, though, may have to do with how we absorb things and whether we can get them through the blood brain barrier. And the blood brain barrier is similar to the placental barrier. So some things that went both ways, I learned about from doing obstetrics. Leslie Zanoff (40:12.558) Okay. Leslie Zanoff (40:20.822) Okay. Leslie Zanoff (40:28.054) Okay. right. Yes, from your knowledge of Dr. Jennifer Schroeder (40:30.978) Always, yeah. I always wanna learn things because you don't know when it's gonna come up again in life where you can apply it. Leslie Zanoff (40:37.262) Well, you are that a lifelong learner. I mean, you I know that just from having conversations with you, but then you're continually getting certified through like the menopause society and then going on beyond OBGYN, family practice to lifestyle medicine. So I'm sure there's others. But yes, yes, the a lifetime to learn. So say it's a perfect Dr. Jennifer Schroeder (41:00.25) For you to be here. Some of lifestyle medicine for me was also, I grew up in a rural area and we ate out of the garden and out of the orchard. And that's how I grew up. We had fresh eggs all the time. So as an adult, I felt the need to get some chickens to have fresh eggs. But how you quantify what lifestyle does for your health is getting dialed in closer and closer all the time. It makes a big difference for your cancer risk. Okay. it makes and that's something when you sit down and you try to decide what's a woman's cancer risk based on her family history. Mm-hmm. None of those questions really helps you understand how much is her lifestyle similar or different than the other people in her family. Because we start to see that now that really her risk may be lower. Because she eats a lot of fruits and vegetables. she doesn't eat a lot of processed food. She's at a healthy weight. Weight makes a difference in her breast cancer risk also. She stays active, she gets enough sleep, her stress level is managed. Those things make a difference. Leslie Zanoff (42:14.318) I think that's so important to call out. Thank you for saying that because yes, just just because it is a generational disease necess of course you need to pay attention to it. And also you might be making better or different choices than your family. That's important to remember too. So thanks for Dr. Jennifer Schroeder (42:32.086) Choices matter. Yes. Yes. Leslie Zanoff (42:36.462) Okay, as running I'm gonna switch gears here a little bit, but as running your own practice while also being an OBGYN and mother, is there a typical day for you? What does that look like? Dr. Jennifer Schroeder (42:51.086) I don't know if there's a typical day. I think that I try to keep the reins on my schedule for everyone's sake. I try to go home from the office at the end of the day feeling like I've done justice to each of my patients and switch gears. Right. And the last few months in thinking about how do I evolve practice. at this point is also leaning into mm taking care of myself. Yeah, I was gonna say spending time with my kids. because in the same way that as a physician, you need to spend time with the patient to understand. Your kids need time. Your spouse needs time. You need time. You need time with the kind of friends who make you laugh so hard that you you know, are half bent over. Yes. those things are good for your soul. And a lot of times when I go biking, I don't bike with anyone. Whether I was road biking, mountain biking, and lots of people say, gosh, maybe shouldn't do that. What if something happens? And I'm like, gosh, that is my peace. when you're riding hard enough that you can't think about anything else, that is peace. And for me, when I started mountain biking, it got me farther out into the woods than I had gotten. in a long time because I wasn't gonna hike that far out. but I could sure bike that far. Leslie Zanoff (44:26.636) Okay. Yeah. Well that was gonna be my question of like what are you doing and how are you taking care of yourself? So that sounds like I know being out in nature and cycling. Always good. Dr. Jennifer Schroeder (44:37.486) It's always good. That's the best. And I think strength training is something lots of women were not taught. Mm-hmm. it's not something I grew up doing, even though I played basketball, I played volleyball, I ran track, I did all of those things. That was not on our radar then. Right. And so I think it's an opportunity now for me to get better at it while I help patients get better at it. Leslie Zanoff (45:04.654) Absolutely. I know. Even if you were so active, me too, I don't think that the weight lifting really came into it until later on. It wasn't it wasn't right. It wasn't part of the journey. Dr. Jennifer Schroeder (45:14.302) That works in our time frame. Yeah. Leslie Zanoff (45:19.416) Do you have advice for women wanting to start their own business? Dr. Jennifer Schroeder (45:24.686) I think believe in yourself on a daily basis, know that you're capable, and have your support team so that you can bounce advice off somebody. they can give you advice rather you can bounce ideas off them. and it leads you into other areas where if you need feedback on something, you can get it. Absolutely you can do it. Leslie Zanoff (45:54.914) Yes, thank you for championing women. I feel like that's something you're really good at too, of collaborating with women. You're always working to do that. I know that's how you and I even met in my new journey of teaching meditation. And it was like, Okay, great, another female practitioner in the health and wellness space, so to speak. Absolutely. I appreciate that. Dr. Jennifer Schroeder (46:20.856) twice. Leslie Zanoff (46:22.278) Medicine and I know we've mentioned a little bit, but it's historically been designed around male patients, male physicians. How has that shaped the challenges that you face just in treating women and in building your career? Dr. Jennifer Schroeder (46:37.198) Think it's challenging both from the perspective of people understanding your value sometimes is not going to be an externally given thing. and as a patient, we spend less and less time with patients in a way that is not good for women. It has not been helpful to us. And I think we have opportunities to step back and reshape how this looks. Even the idea that when I went to medical school, anybody who applies for medical school, they're looking for someone who best and brightest. How do you do in school? What's your GPA? What's your MCAD score? Have you done some service? Do you know what you're getting into? when you are leaving residency. How you're reimbursed is not how smart you are. Okay. Not the same. You're reimbursed if you do procedures by far to a greater degree. That doesn't mean you don't need to be smart to do that. But if you're very good with patience and you're smart and you spend the time, that is not the person who gets the most reimbursed, even if they have the most skill. Leslie Zanoff (48:03.118) Okay. I mean, that there that is such a a deep dive that you know, we could go down. And that's unfortunate because that's what we need, right? In the in the more than maybe our traditional healthcare system is set up, more than the fifteen minutes that we're allowed, which I know is is that part of the reason when you that you went on your own and you're able to see patients for a little bit longer. Dr. Jennifer Schroeder (48:31.534) Went on my own because at the end of the day I want to feel like my priorities are aligned. So that's easy for me to do when I'm in my own practice. Right. If I choose to slow down, then I have a choice. If I want to make the same amount of money, I can sort out another way to do it or another reimbursement model. or I can choose to make less. Leslie Zanoff (48:58.477) Okay. Dr. Jennifer Schroeder (48:59.288) I think there are ways to do that. I always want to come home feeling like I have done the right thing. And I want to have as many tools in my toolbox to do that. I don't want to be at an institution or at an academic center where I'm restricted in using tools because of someone else's priorities. Leslie Zanoff (49:18.892) Okay. Well yeah. Dr. Jennifer Schroeder (49:22.104) Because my job is to take care of you. Leslie Zanoff (49:24.6) Yes. Dr. Jennifer Schroeder (49:25.666) Do no harm and do the right thing. Leslie Zanoff (49:28.622) Okay. Well, I think you're doing that. So kudos to And in that same vein, right? And just talking about maybe there's one thing about our the way our healthcare system handles women's health, what would you change? Like what would it be and why? Dr. Jennifer Schroeder (49:33.027) You Leslie Zanoff (49:49.332) I don't know, maybe it's a hope for healthcare. Dr. Jennifer Schroeder (49:52.934) a hope for health care is that The physicians the providers. Dr. Jennifer Schroeder (50:05.166) Find space to take care of themselves because more people are leaving healthcare than ever. That's not going to help the rest of us. Right. I understand that burnout. but I think understanding the value that those people bring to the table is imperative. Dr. Jennifer Schroeder (50:28.81) Valuing someone who is able to emotionally connect with a patient and understand their issues, that does take a bit of time. I I think the model's gonna evolve. primary care is in a very hard place right now. and I think it's it's has to evolve. for us to continue to be successful and to people to continue to get care. Sometimes I think that the vet spends more time with your pet than doctors do with the with the patient. Leslie Zanoff (50:52.344) Yeah. Dr. Jennifer Schroeder (51:07.314) And that in and of itself speaks volumes about what service do we do for one another? Mm-hmm. and for all the healthcare dollars we throw at it, it's not structured correctly. Because all the physicians are not going home wealthier than they were before, by far the opposite. And they're more stressed out. And the idea of moral injury very much is real that trying to balance your own your own health, the time you have with your family, versus feeling like you take good care of patients and that you your hands are not tied from doing the right thing. Absolutely. See it all the time. Feel it frequently. Leslie Zanoff (51:53.57) Well yeah, and that's you know, that's hard. I mean, that's what I was gonna say. How do we how do patients help physicians in that regard? Dr. Jennifer Schroeder (52:04.718) I had a three-week stretch of time that I ran my own office, meaning I was literally the only person there. I would not advise it for everyone. Many physicians would not do it. I was lucky that I had worked with my EHR company and had structured self-check-in, but hadn't fully moved over to it. So I moved over to self-check-in. Okay. My husband, my friends, when I said, by the way, guess what I'm doing right now? You know, the look on their face of horror, like, how can you possibly be doing that? That's gotta be terrible. Honestly, it really wasn't terrible. Mm-hmm. When patients understood that I was the only one there and I needed them to do a thing for me. And I would be with them as soon as I could, everybody else kind of dialed back. Mm-hmm. Because they understood, I'm still showing up for you. Leslie Zanoff (53:02.211) Right. Dr. Jennifer Schroeder (53:03.37) And they were much more patient. they were much less demanding. And they still got all of their needs met. Okay. But it set a different tone of I'm here for you. but I need you to sometimes just be patient. or let me work on that issue. but don't come at me in in In the midst of emotion. Leslie Zanoff (53:34.402) Right. Well, and this probably speaks to too why more physicians are leaving, you know, they are leaving and why many of them stay in a bigger healthcare system because not only is it running your own business and the challenges with that, you know, yeah, you're doing a lot, so there needs to be some patience. Dr. Jennifer Schroeder (54:01.484) patients and I think just some sometimes just a dose of humanity. because I don't want to ask things that are unreasonable. but I think we get so busy in life. Mm-hmm sometimes we have to slow down and take a breath and see the humanity in somebody else before we all need the people will be helpful. but we have to Leslie Zanoff (54:06.274) Yes. Leslie Zanoff (54:23.31) Absolutely Dr. Jennifer Schroeder (54:29.984) sometimes give benefit of the doubt first. Mm-hmm. Leslie Zanoff (54:33.09) Yes. Absolutely. We talked about this a little bit, but going back to women who know that something's wrong, but the labs are coming back normal. What what do we do? What do you say to that? Dr. Jennifer Schroeder (54:49.132) think if the labs are normal and you don't feel right. if your provider says that's all I can do, you don't have the right provider. And and you should probably keep looking because they are going to look normal early in peri menopause. Leslie Zanoff (55:07.318) Okay. Right, depending on and two, maybe depending on where you are, like you mentioned earlier, at the point in your cycle. Uh-huh. Dr. Jennifer Schroeder (55:16.812) Right. They're gonna look very different in different parts of your cycle. women have a lot of symptoms before they stop having periods. And they're coming because they feel poorly. And very often, what breaks the back, the final, the final straw is very often brain fog. I can't think at work, I can't keep things organized, I miss my child's appointment. When brain fog hits, at least for me, I was like, Hey, I'm done. This is got some's gotta give. What? Absolutely. it's one thing to emotionally not feel like yourself, but I can't go to work and feel like I cannot do my job at the level I expect of myself if my brain is not working correctly. brain fog is a no go for me. Leslie Zanoff (55:52.917) Scary. Leslie Zanoff (56:10.072) Right. For most people. Dr. Jennifer Schroeder (56:12.646) and my labs would have looked normal then. Uh-huh. But even my husband could tell when you're doing word finding, you use another word in place of it after a pause because you just can't think of that word, but it's right there. Yes. you feel silly. Uh-huh. you know, my kids would tease me about it. Yes. And I understand what it is. And some of that, as you get that. It's an opportunity to treat people to help them buffer that because there does seem to be a time window when some symptoms are worse as your hormones are changing. And I told a woman this morning it's like the estrogen's gone down and it's not doing its job to keep the joints lubricated and the tendons hydrated enough. But you know. Your body looks around at well, who's gonna pick up that job? I don't know, we haven't decided yet. Let us think on that. We'll get back to you. Well, estrogen's not there anymore. And so that time window until your body kind of readjusts, that couple of years can really feel like a, you know, a wild ride. Leslie Zanoff (57:19.704) Well, do things level off when you get to menopause, when you're going through this zone of chaos, so to speak, in perimenopause, and then we hit menopause. Dr. Jennifer Schroeder (57:31.692) It it tends to happen a little while after that. It's a couple of years before and a year or so after that tend to be the most chaotic. that doesn't mean it's easy after that. I have women who are sixty-five and they have hot flashes if I try to to it to get them off their hormones and they can't do it. They can't think and they can't sleep. Mm-hmm. And so most women by then it will settle more. But sometimes it's really that transition period that is Leslie Zanoff (57:34.2) Okay. Leslie Zanoff (57:39.671) Okay. Dr. Jennifer Schroeder (58:00.646) the ultimate chaos. Leslie Zanoff (58:02.286) Right. And speaking of that, the sixty five plus, right? That's an area, from what I understand, correct me here, that there's still not a lot of research for do we stay on hormones, do we not? Dr. Jennifer Schroeder (58:16.694) It's a big area of of potential research. The women's health initiative study. does give us some information that once you get past about age 60, that's always a a time period when I go back and I talk to my patients about how are you doing? How do you feel? Do you think we can adjust down or not? We we don't have a lot more research in the way that we want. Okay. And being able to dial that into the individual, I think, is one of the things that I do. And it's another Sheer decision making about the women's health initiative study look like the risk may start to go up then for cardiac disease, okay. for breast cancer. Leslie Zanoff (59:06.146) Okay. Dr. Jennifer Schroeder (59:08.078) But thinking back, those were also done with not exactly the same hormones we use today, meaning that was premarin very often and things that are a little bit different than we use today. Leslie Zanoff (59:21.294) Okay. Like the progestins versus the progesterone. Dr. Jennifer Schroeder (59:24.706) Progesterone. Uh-huh. there are even studies out of Europe about for years when we did contraception, there were a whole variety of different progesterones. And then there was ethanol estradiol. And there was not a different kind of estrogen you could use until a birth control came out five ish years ago. That was a different combination. Some women do not have the same impact depending on which progesterone you use. And some of the risk of that does not look the same in every single progesterone. Those molecules are not exactly the same. And how our body sees them and is affected by them is not exactly the same. Sometimes I have to run through a couple different contraceptives to find one that will fit someone's mood because two of them were a no go. Okay. And then we find something that's a fit. Leslie Zanoff (01:00:22.2) Okay. Right. The trial and error. I mean to know too. I think that's just important for women to know that you it might all not always be right the first time. You might have to try a few things. Yeah. Dr. Jennifer Schroeder (01:00:34.708) And that it's okay to say this is not quite right. because there are choices. Leslie Zanoff (01:00:39.308) Right. Let's talk about the correlation between hormones and mood. Will you kinda talk about that for a little bit? Sure. Dr. Jennifer Schroeder (01:00:47.014) I think we've learned a lot from menopause and perimenopause about how much our hormones are intertwined with our neurotransmitters. and it was an opportunity to kind of look back at what is premenstrual dysphoric disorder about when a woman's mood just sinks. the few days of the week before a period. Why, why is that timing happening for someone? and why do some women get postpartum depression or postpartum anxiety? Those things have to do with those interactions between both. And so I was able, since I had done deliveries and seen lots of postpartum women and lots of women doing birth control. Leslie Zanoff (01:01:29.016) Right. Dr. Jennifer Schroeder (01:01:44.398) to think about how much progesterone can make us less anxious. the there's a prescription medication out now to help with postpartum depression that was not available and it's really a progesterone type substance and so it helps us think about and it's the shift after you have a baby Leslie Zanoff (01:01:59.303) wow. Dr. Jennifer Schroeder (01:02:12.82) And your body is readjusting, similar in my mind, to when you're close to menopause or just past menopause, and your body is in that readjustment period. Having support sometimes for your hormones andor your neurotransmitters is significant. So the idea for a while that when women came in with perimenopausal mood issues, that we used perhaps an SSRI in the past or something else wasn't completely wrong. It was well intended. At the time, it was perhaps what they thought they should do. But it was only part of the answer. Right. because those things interplay. And I think that part is very often what underlies when somebody says, I just don't feel like myself, is that it's starting to change enough that you don't feel like yourself. And there are good and bad things to that. Sometimes it means that you are more apt to draw boundaries where perhaps they should have been before and not do everything for everyone and let them do some things for themselves sometimes. But in all seriousness, being able to get to the root of understanding when someone's in that transition period and their hormones are resetting, that they may need some other support from progesterone, from some other moon medication because those things are interrelated. And sometimes how you may react to those moon medications, knowing that you can do some genetic testing with people if you're not getting them dialed in can help you get the rest of the way. But those two things are very important when you're in a transition period. Leslie Zanoff (01:04:00.066) Well, and then I think too, I've heard you speak on women's level of anxiety during this midlife perimenopausal time where I said I've said it on this podcast before that your brain is trying to figure out what's happening and the anxiety where you may not have suffered from anxiety before, can all of a sudden you're like, my gosh, I feel anxious and I don't know why. Right? Is that Dr. Jennifer Schroeder (01:04:25.902) Sometimes you can trace it back to an event, but very often you can't. And I think sometimes we don't speak about that symptom because it feels scary to feel anxious without a reason. there may be a lot of validity to it. Leslie Zanoff (01:04:41.218) Yes. Yeah. Or the rage. Dr. Jennifer Schroeder (01:04:46.71) Yes. I mean even so one of the interesting symptoms is sometimes you can get some mesophonia where sounds can feel different. And so I would sit in the kitchen and work at my desk and my husband would come and scoop up some ice to make some ice water. And literally the ice sound was so loud to me. And I just started laughing one day. And I turned to him and I said, I know you're not doing that loudly. You would not believe how loud that is. And he looked at me like, is this a menopause thing? I mean, because he and I have lots of conversations about it, but small little things that gosh you would never think of before. And they sound crazy. It sounded crazy to me. No. I and I and I fully admitted that to him. I know this sounds crazy, but I'm telling you, it it feels very different. Leslie Zanoff (01:05:41.814) Is there another correlation similar to that, but with scent? Because some smells, like my mom had gotten me a candle and this was one of my favorite candles I love all the time. And then when I tried to burn it in recent months, I'm like, I this smells terrible. I don't like this anymore. Yes. Dr. Jennifer Schroeder (01:05:59.704) I don't know. Yes. I I think as we learn more about our neurological system I wouldn't say yes. Leslie Zanoff (01:06:05.72) Right. I mean, it just has I'm telling myself it has my gosh. Okay. That's okay, good. What's the best advice that you've been given? It could be personal, professional. Dr. Jennifer Schroeder (01:06:23.182) I think the best thing I've been told over time is that I was capable, that I could do whatever I wanted to do. And that came from my household growing up. Okay. That set a pathway for me that is the same pathway that I set for my kids. because it allows you to go anywhere you want to go. And I think the idea that someone believes in you, no matter what happens in life, that you are capable and that you have choices is so important. Leslie Zanoff (01:07:01.974) It is so important. Is that something that you are talking to your kids about a lot? Like all the time? All the time. Right? Constantly reminding them. Yes. Dr. Jennifer Schroeder (01:07:12.192) Me too. Find something in life that you really love that you think is interesting, that you're good at, and that you can make enough money that you're happy and stable. Mm-hmm. Independent of whether you get married, whether you don't get married, dial yourself in to be able to take care of yourself. Mm-hmm. Life is easier and then you have more choices. Mm-hmm. Mm-hmm. Leslie Zanoff (01:07:31.873) Ko yourself. Leslie Zanoff (01:07:37.582) Do you have any non-negotiables in your life? Like I will do these things, not these others. Dr. Jennifer Schroeder (01:07:45.626) I have to be able to ride my bike. That is that is on my list. and at the end of the day I need to feel okay about how I conduct myself. in my career with my kids, with my spouse, that I feel like I've done the right thing. Leslie Zanoff (01:08:07.564) And since this podcast is called A Lifetime to Learn, what lesson took you the longest to learn, or maybe something you're still learning? Dr. Jennifer Schroeder (01:08:18.888) Two things I can think of. Some things in life are timing. And sometimes no answer is an answer. That when you're someone who teaches a lot, you're not obligated to take care of every single thing and to respond to every single thing. Leslie Zanoff (01:08:42.401) Yes. I like that. Dr. Jennifer Schroeder (01:08:43.406) Yes. Take note. Take note. Leslie Zanoff (01:08:50.381) Okay, well tell me where people can find you. It, would that be like a website, or where you're located in Bentonville. Dr. Jennifer Schroeder (01:08:58.478) On twenty eighth street. it's Embrace Family Medicine and One Self Health. Leslie Zanoff (01:09:05.166) Okay. And I'll link it in the show notes too.. Thank you for being here. Dr. Jennifer Schroeder (01:09:10.583) Likewise, thanks for having me. It was a pleasure. Leslie Zanoff (01:09:13.528) Thanks for being here on A Lifetime to Learn. If today's episode inspired you or sparked a new thought, please share it with someone who might need it too. And if you haven't yet, be sure to subscribe to get notifications when we launch new episodes. I've got conversations with extraordinary people lined up, and I can't wait for you to listen. For more information on how to work with me, visit lesliezanoff.com. It's where I share resources to help you lead with presence. And live with intention. Because remember, we're not here to have it all figured out. We're here to keep showing up with open hearts and open minds because we've got a lifetime to learn. Until next time, friends, be well.