Latest / Clearly Hormonal / Ep 40: When Menopause Sends You to the ER with Dr. Jessica Yearwood

Transcript

Ep 40: When Menopause Sends You to the ER with Dr. Jessica Yearwood · Clearly Hormonal

• 0:02
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the podcast where women's health takes center stage.
• 0:07
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:08
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert.
• 0:13
  Dr. Komal Patil-Sisodia: This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider.
• 0:24
  Dr. Komal Patil-Sisodia: Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place.
• 0:31
  Dr. Komal Patil-Sisodia: As a physician, my goal is to educate on this podcast.
• 0:34
  Dr. Komal Patil-Sisodia: The content shared here is for informational purposes only and should not replace personalized medical advice.
• 0:41
  Dr. Komal Patil-Sisodia: If something we discuss resonates with you, please talk to your healthcare provider at your next visit.
• 0:46
  Dr. Komal Patil-Sisodia: Now let's dive in and help you reset, recharge, and take control of your health.
• 0:55
  Dr. Komal Patil-Sisodia: Welcome back to another episode of Reset Recharge.
• 0:57
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:58
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, and I'm excited to introduce our guest this week, Dr.
• 1:03
  Dr. Komal Patil-Sisodia: Jessica Yearwood.
• 1:04
  Dr. Komal Patil-Sisodia: Jessica and I, first met at a.
• 1:07
  Dr. Komal Patil-Sisodia: Conference for female physicians called Brave Enough in 2021.
• 1:11
  Dr. Komal Patil-Sisodia: We met through a mutual physician friend, and I was so excited when she reached out to me, to let me know that she was delving into menopause care and is now a Menopause Society certified practitioner.
• 1:21
  Dr. Komal Patil-Sisodia: A little bit of background on Jessica.
• 1:23
  Dr. Komal Patil-Sisodia: She grew up in Puyallup in Washington state.
• 1:26
  Dr. Komal Patil-Sisodia: Went to undergrad at the University of Puget Sound and Medical School at Medical College of Wisconsin.
• 1:32
  Dr. Komal Patil-Sisodia: She graduated in 2006 and did her residency training in emergency medicine at Yale, where she also worked as a clinical instructor for a few years before moving back
• 1:41
  Dr. Jessica Yearwood: to Washington State for, community practice.
• 1:44
  Dr. Komal Patil-Sisodia: There's no place like home.
• 1:45
  Dr. Komal Patil-Sisodia: Every friend of mine that's in our age range that left the state, came back with their families.
• 1:50
  Dr. Komal Patil-Sisodia: I grew up here as well, so yeah, everybody's back from Washington.
• 1:54
  Dr. Komal Patil-Sisodia: It hard to stay away.
• 1:55
  Dr. Komal Patil-Sisodia: Yeah, it is.
• 1:56
  Dr. Komal Patil-Sisodia: It's like a hidden gem that most people dunno about, but here we are broadcasting it to everyone who's listening.
• 2:02
  Dr. Komal Patil-Sisodia: I was really excited to interview you today, Jessica.
• 2:06
  Dr. Komal Patil-Sisodia: Welcome to the show.
• 2:07
  Dr. Komal Patil-Sisodia: I'm so excited to have you here because you have such a unique perspective on menopause I'd love to hear from your words what led you to this type of care and inspired you to take this path.
• 2:21
  Dr. Jessica Yearwood: Thanks for having me, and I'm excited that we did get a chance to reconnect here, and learn, from your experience in menopause care.
• 2:28
  Dr. Jessica Yearwood: I got interested, driven by my own health symptoms and, answers that I wasn't getting from the physicians that I was seeing.
• 2:37
  Dr. Jessica Yearwood: And so I ended up, finding and joining the Menopause Society initially to get access to the clinician based education that they had.
• 2:45
  Dr. Jessica Yearwood: I needed to educate myself.
• 2:48
  Dr. Jessica Yearwood: Then I looked into more specific, hormone prescribing courses the more I, learned, motivated by trying to figure out what was going on with me, I started to notice a lot of similarities in what was going on with patients that I was currently seeing and then looking back, had seen over the years, in my emergency medicine practice.
• 3:09
  Dr. Komal Patil-Sisodia: Yeah.
• 3:10
  Dr. Komal Patil-Sisodia: And a lot of times women will go into their primary care doctor's office or seek out regular care and they're not necessarily getting answers to their symptoms, right?
• 3:20
  Dr. Komal Patil-Sisodia: So they keep thinking that, oh, my labs are normal.
• 3:23
  Dr. Komal Patil-Sisodia: There's nothing really that they're finding.
• 3:25
  Dr. Komal Patil-Sisodia: And then it scares people to a level of if they can't figure out, maybe it's something more dangerous and maybe I need to end up in the emergency room.
• 3:33
  Dr. Komal Patil-Sisodia: Is that what you're seeing?
• 3:35
  Dr. Jessica Yearwood: Yeah, absolutely.
• 3:36
  Dr. Jessica Yearwood: I think there's such, an overlap between, some very serious health conditions and symptoms that are brought on by the hormonal changes of perimenopause and menopause.
• 3:48
  Dr. Jessica Yearwood: If you're patient and you've had some kind of minor symptoms or ongoing symptoms, that you don't have answers to or suddenly have really significant symptoms out of the blue, and you're very scared and you need to go get some answers.
• 4:04
  Dr. Jessica Yearwood: I think it is important to say too that, the symptoms of perimenopause and menopause are a diagnosis of exclusion.
• 4:11
  Dr. Jessica Yearwood: There's not a test that's gonna say, this is absolutely perimenopause, or this is menopause.
• 4:16
  Dr. Jessica Yearwood: We need to do some testing at times to figure out what isn't going on, before we move on and say, okay, I think that we can attribute this to some hormonal changes and, start some treatment and see if that helps.
• 4:31
  Dr. Komal Patil-Sisodia: I think that's great perspective, because some of the symptoms of menopause can be the symptoms that present in life-threatening conditions, right?
• 4:40
  Dr. Komal Patil-Sisodia: Absolutely.
• 4:40
  Dr. Komal Patil-Sisodia: If you are not sure which one is which, it's best to do your due diligence, but then if all of that is ruled out, we have to look to other things.
• 4:48
  Dr. Komal Patil-Sisodia: I would love to, chat with you.
• 4:51
  Dr. Komal Patil-Sisodia: Go through just the top things that you are seeing when women come into the er, which menopausal symptoms you see creating the most number of women coming through, and how you can tell if something is hormone related versus not, and something more dangerous.
• 5:08
  Dr. Komal Patil-Sisodia: I'd love to work through that with you, and jump into each of the different organ systems.
• 5:12
  Dr. Komal Patil-Sisodia: Let's start with cardiovascular.
• 5:14
  Dr. Komal Patil-Sisodia: This one is near and dear to my heart because of everything my mom went through at such a young age, being diagnosed with heart disease in her forties after having a hysterectomy earlier on.
• 5:24
  Dr. Komal Patil-Sisodia: We know that menopause when, not treated, especially in younger women, will lead to increased risk of cardiovascular disease.
• 5:32
  Dr. Komal Patil-Sisodia: We know that cardiovascular disease presents differently in women compared to men.
• 5:36
  Dr. Komal Patil-Sisodia: I'd love to hear if you could give us a snapshot of the average woman who comes in and what that looks like.
• 5:42
  Dr. Jessica Yearwood: One of the biggest, symptoms is gonna be palpitations.
• 5:46
  Dr. Jessica Yearwood: Palpitations basically is when you experience an abnormal heartbeat and that can be variable for a lot of different people.
• 5:52
  Dr. Jessica Yearwood: You could feel like your heart is racing.
• 5:54
  Dr. Jessica Yearwood: You could feel like your heart is skipping a beat or catching.
• 5:57
  Dr. Jessica Yearwood: It could, be a couple of beats or it could last for seconds or minutes or sometimes even hours.
• 6:03
  Dr. Jessica Yearwood: And, some other accompanying symptoms that might occur is dizziness or lightheadedness with it, or even a feeling of, difficulty breathing or you can't catch your breath or even chest pain palpitations, are a vasomotor symptom, of perimenopause and menopause, but there's also other underlying diagnosis that are more serious, and medical conditions that need to be evaluated when someone is having palpitations.
• 6:28
  Dr. Jessica Yearwood: When people come in and, are evaluated in the emergency department for those symptoms of palpitations, one of the first things we do is get a, electrocardiogram, or you may have heard that, called an ECG or an EKG.
• 6:39
  Dr. Jessica Yearwood: And that's looking at the electrical conduction system of the heart.
• 6:42
  Dr. Jessica Yearwood: There's a very normal pattern that we see when we look at the EKG, that tells us that the electricity, which drives how the muscle squeezes and moves the blood, through the heart and into the body.
• 6:52
  Dr. Jessica Yearwood: When someone's having palpitations, we certainly look for abnormal electrical, patterns that might be an underlying cause of those palpitations.
• 7:00
  Dr. Jessica Yearwood: Palpitations can be benign.
• 7:02
  Dr. Jessica Yearwood: We all get extra beats, premature atrial contractions or premature ventricle contractions.
• 7:08
  Dr. Jessica Yearwood: Everybody experiences or feels those differently, but when they happen frequently, they can be really, bothersome.
• 7:15
  Dr. Jessica Yearwood: One of the things to point out is when we're getting that ECG if you aren't having symptoms at that time, we may miss, what was causing those symptoms.
• 7:25
  Dr. Jessica Yearwood: We don't necessarily, stop there.
• 7:27
  Dr. Jessica Yearwood: We'll check some blood work.
• 7:29
  Dr. Jessica Yearwood: Getting a complete blood count, making sure that someone isn't anemic or having a low red blood cell count, which can drive some symptoms of palpitations, as well as those other symptoms of chest pain or shortness of breath, dizziness, lightheadedness, even passing out.
• 7:43
  Dr. Jessica Yearwood: We usually check a complete metabolic panel, which is your electrolytes, so your potassium, calcium, magnesium.
• 7:50
  Dr. Jessica Yearwood: Even sodium are all very important in how the electricity, runs through your entire body.
• 7:56
  Dr. Jessica Yearwood: Sometimes, checking some heart enzyme tests to see if there was any damage to the heart muscle.
• 8:01
  Dr. Jessica Yearwood: We may be, checking, and sending thyroid tests.
• 8:04
  Dr. Komal Patil-Sisodia: Are up in my office.
• 8:05
  Dr. Jessica Yearwood: Near and dear to your heart.
• 8:06
  Dr. Jessica Yearwood: It depends.
• 8:06
  Dr. Jessica Yearwood: Sometimes we won't get those thyroid tests back, in the emergency department.
• 8:10
  Dr. Jessica Yearwood: There's other symptoms that we're looking for that may go along with, really high thyroid, function or really low thyroid function, that we might ask the lab to run those tests, faster.
• 8:21
  Dr. Komal Patil-Sisodia: What I'd love to hear is when people are having these symptoms, what are the major things that you are looking for that are life threatening?
• 8:29
  Dr. Komal Patil-Sisodia: Let's talk about those first and then how the symptoms of those are different than what you may experience in menopause.
• 8:36
  Dr. Komal Patil-Sisodia: Because there are always subtleties but when I am self diagnosing online and looking at stuff that's not in my specialty, I think this is a universal experience for anybody who's worried about something that's going on in their body, whether they're a medical professional or not.
• 8:52
  Dr. Komal Patil-Sisodia: Just reading a list of symptoms can convince you that you have something.
• 8:56
  Dr. Komal Patil-Sisodia: But when we come in to see an expert like you it would be great to hear your perspective on what the serious conditions are, and how we can differentiate.
• 9:04
  Dr. Jessica Yearwood: Yeah, absolutely.
• 9:05
  Dr. Jessica Yearwood: So those serious conditions are arrhythmias.
• 9:08
  Dr. Jessica Yearwood: We're looking for atrial fibrillation, we're looking for the supra ventricular tachycardias.
• 9:12
  Dr. Jessica Yearwood: We're looking for ventricular tachycardias.
• 9:14
  Dr. Jessica Yearwood: The things that are driving your heart to beat much faster, than normal, causing that feeling of racing heart, and other symptoms.
• 9:22
  Dr. Jessica Yearwood: If you are actively having symptoms and we see one of those conditions is going on, then we're gonna, treat it in the way that we need to.
• 9:31
  Dr. Jessica Yearwood: If you are having symptoms and none of those things are going on, we're immediately reassured that your symptoms are not tied to those, dangerous, arrhythmias, it doesn't mean that other things might not be going on, but, usually if you are experiencing symptoms and we have you hooked up to the EKG monitor or the telemetry monitor and we're not seeing any abnormal electrical activity, that's definitely reassuring that maybe something else is going on.
• 9:59
  Dr. Jessica Yearwood: things that are going to differentiate, more of those dangerous things from.
• 10:04
  Dr. Jessica Yearwood: menopausal and hormonal related things are symptoms that are not necessarily, sustained.
• 10:09
  Dr. Jessica Yearwood: Symptoms that come and go that are more, brief in nature, symptoms that are not necessarily, associated with other things like significant chest pain or, ongoing difficulty breathing, having symptoms when you don't have a lot of other medical risk factors for the big, bad, scary things.
• 10:29
  Dr. Jessica Yearwood: So I would be more concerned if someone's having symptoms, if they have underlying known cardiovascular disease, if they have underlying, diabetes or high blood pressure, strong family history of, some of these other, dangerous conditions.
• 10:44
  Dr. Jessica Yearwood: I think those are some things that will differentiate, dangerous and not dangerous.
• 10:50
  Dr. Komal Patil-Sisodia: How many do you estimate actually end up having something that is life threatening versus what would you estimate the percentage of women who are coming in with significant menopause symptom?
• 11:00
  Dr. Jessica Yearwood: That percentage is gonna shift and change, probably as, the younger, women, probably less likely to be having some of those dangerous things.
• 11:09
  Dr. Jessica Yearwood: Percentage probably increases as we, get older and make it into those sixth, seventh, eighth decades of life.
• 11:16
  Dr. Jessica Yearwood: But I would say overall the, majority of patients that come in, do not have something more serious going on or have more benign conditions like premature atrial contractions or premature ventricular contractions.
• 11:30
  Dr. Jessica Yearwood: The majority, are not being admitted to the hospital or given a specific, diagnosis.
• 11:36
  Dr. Jessica Yearwood: When they're discharged.
• 11:37
  Dr. Komal Patil-Sisodia: Can you talk a little bit about how estrogen loss may lead to some cardiovascular changes or, contribute to what these patients are feeling?
• 11:47
  Dr. Jessica Yearwood: As you've talked about before on your podcast, we transition, through perimenopause and menopause and estrogen goes down, those cardiovascular risk factors that estrogen has actually been protected for.
• 11:59
  Dr. Jessica Yearwood: So elevated blood pressure, lipid profiles, development of atherosclerotic disease, are unmasked, and, increased as we lose estrogen.
• 12:09
  Dr. Jessica Yearwood: as, patients are getting older, or getting beyond, those.
• 12:13
  Dr. Jessica Yearwood: Years of their final menstrual period, into the post menopause state, our suspicion for more of those serious things, needs to be higher.
• 12:20
  Dr. Jessica Yearwood: And, we need to be aware of that.
• 12:23
  Dr. Komal Patil-Sisodia: we talked about that.
• 12:25
  Dr. Jessica Yearwood: Do you want me to say something about, if you end up, in a situation where you're concerned about going in or not, erroring on the side of caution, and then maybe, being aware because maybe your physician is not aware to tell you about things to follow up, or you may need some outpatient testing
• 12:40
  Dr. Komal Patil-Sisodia: can you talk a little bit about what takeaways you want women who are leaving the emergency room with cardiac symptoms and a negative workup for something dangerous, which is great news, but how can they follow up as an outpatient and get the help they need?
• 12:55
  Dr. Jessica Yearwood: Yeah, that's a great question.
• 12:56
  Dr. Jessica Yearwood: You certainly need to be, your own biggest, advocate.
• 13:00
  Dr. Jessica Yearwood: The information, that emergency medicine doctors have about the impact of perimenopause and menopause, on these presenting symptoms is definitely variable.
• 13:09
  Dr. Jessica Yearwood: Just because the testing we can do.
• 13:12
  Dr. Jessica Yearwood: When you come to the emergency department is negative or hasn't given us a specific diagnosis.
• 13:17
  Dr. Jessica Yearwood: It doesn't mean your symptoms aren't real.
• 13:19
  Dr. Jessica Yearwood: It doesn't mean what you're experiencing isn't valid.
• 13:21
  Dr. Jessica Yearwood: It doesn't mean there isn't other testing that might need to be done.
• 13:25
  Dr. Jessica Yearwood: in the case of palpitations, a lot of people may warrant extended monitoring.
• 13:29
  Dr. Jessica Yearwood: Referral for something like a Holter monitor or patch that will monitor over days or even weeks to see if there is something underlying that didn't show up in the emergency department.
• 13:40
  Dr. Jessica Yearwood: Some people may need additional testing, like an echocardiogram, or ultrasound of their heart to make sure everything structurally looks, fine.
• 13:48
  Dr. Jessica Yearwood: They may need to talk to their doctor about.
• 13:51
  Dr. Jessica Yearwood: How this plays in with potentially other perimenopause or menopausal symptoms that they're having and talk about, if they are a good candidate for a trial of hormone therapy to see if that helps the symptoms, while maybe they're getting additional testing done.
• 14:06
  Dr. Jessica Yearwood: I attended the Annual Menopause Society meeting recently and there was, a lot of discussion about, chest pain in, this age group, of women and, really how cardiovascular, risk is underestimated, in women in general.
• 14:24
  Dr. Jessica Yearwood: there are some different, pathophysiology or, the way things happen in the body in women, with regards to cardiovascular disease that may not necessarily show up.
• 14:35
  Dr. Jessica Yearwood: On the traditional ways that we test or look for those things in the emergency department.
• 14:40
  Dr. Jessica Yearwood: So people may be coming in with chest pain and, we may not see the big changes that we look for a big heart attack on the EKG.
• 14:47
  Dr. Jessica Yearwood: Or we may not see changes on the lab testing that we, check, something called a troponin, which looks for heart muscle damage, when blood flow has been cut off to the heart muscle in a heart attack.
• 14:58
  Dr. Jessica Yearwood: If you walk away without specific answers, try not to feel disappointed, advocating for yourself, following up and knowing that, there could be a role for hormone therapy to help with some of these symptoms.
• 15:11
  Dr. Komal Patil-Sisodia: That's great advice you wanna hear Something interesting I learned this last week is that biotin can make troponins be falsely negative.
• 15:19
  Dr. Komal Patil-Sisodia: How many women do you know are on biotin for hair, skin, and nails?
• 15:23
  Dr. Komal Patil-Sisodia: If it's a radio immunoassay that's being used for the troponins, they can sometimes be falsely negative in women.
• 15:29
  Dr. Komal Patil-Sisodia: I had no idea until last week, I always tell everybody about biotin for their thyroid function test because it will mess with those.
• 15:36
  Dr. Komal Patil-Sisodia: It doesn't actually cause an issue.
• 15:38
  Dr. Komal Patil-Sisodia: But in the cardiovascular space, it was so scary to think that something so benign that we tell people to take for their hair, skin and nail can have such a profound impact.
• 15:49
  Dr. Komal Patil-Sisodia: I can't even imagine, being on the receiving end of that and have that missed.
• 15:52
  Dr. Jessica Yearwood: For the listeners if they are on biotin supplements and they do end up in the emergency department with, chest pain symptoms and a troponin is being done.
• 16:01
  Dr. Jessica Yearwood: To ask if it's a, biotin, sensitive, assay.
• 16:05
  Dr. Jessica Yearwood: I'm gonna have to go back to our lab and ask that question.
• 16:08
  Dr. Komal Patil-Sisodia: I was gonna do the same thing at our hospital because I oversee some of the medical specialties clinics, not cardiology, but it was something that popped up in my head and there's so many women in my clinic, who are convinced that it's their thyroid or something else that's causing their hair loss, and so they're trying to grow it back with biotin.
• 16:26
  Dr. Komal Patil-Sisodia: All these things we learn when we finally all get a chance to talk to each other and compare expertise.
• 16:30
  Dr. Komal Patil-Sisodia: Let's move on to the genital urinary, system.
• 16:33
  Dr. Komal Patil-Sisodia: UTI is a big, issue in women, especially as they start to get later in perimenopause and into post menopause.
• 16:43
  Dr. Komal Patil-Sisodia: I'd love to hear from you, like what are the things that you're seeing coming into the ER and what is your approach to dealing with it, depending on the age of your patient?
• 16:52
  Dr. Jessica Yearwood: Yeah.
• 16:53
  Dr. Jessica Yearwood: I think UTIs, and, vaginal symptoms, itching, discharge, are really, big complaints that end up bringing people into the emergency department.
• 17:04
  Dr. Jessica Yearwood: Especially, two or three in the morning when the symptoms start, you can't sleep and it's really inconvenient and it's a Friday night and, everything else is gonna be closed over the weekend.
• 17:14
  Dr. Jessica Yearwood: This is huge.
• 17:15
  Dr. Jessica Yearwood: The declining levels of estrogen, in perimenopause and menopause.
• 17:19
  Dr. Jessica Yearwood: Affect the genital urinary system and tracted, immensely.
• 17:23
  Dr. Jessica Yearwood: There's architectural changes to the tissues, that, overall, I guess reduce the health of these tissues.
• 17:30
  Dr. Jessica Yearwood: Reduce their ability to, of the immune function, system, the gatekeeping system that keeps everything, from getting, infections, all of the bacteria in the gastrointestinal tracts, that live on the skin, around the vulva and the perineum, around the rectum.
• 17:45
  Dr. Jessica Yearwood: Those are the typical, bacteria or pathogens or bugs that cause urinary tract infection.
• 17:51
  Dr. Jessica Yearwood: As the tissue starts to change from that loss of estrogen.
• 17:55
  Dr. Jessica Yearwood: The normal function of preventing those infections, decreases.
• 17:59
  Dr. Jessica Yearwood: There's increased risk of having those infections and recurrent infections, those can present, burning urgency, frequency, blood in your urine, lower abdominal pain or pelvic pain.
• 18:11
  Dr. Jessica Yearwood: If you've ever had one, it's pretty uncomfortable.
• 18:13
  Dr. Jessica Yearwood: Typically antibiotics are the mainstay treatment of a, true urinary tract infection.
• 18:20
  Dr. Jessica Yearwood: What we're doing to test for that is getting a urinalysis, which is looking for, really secondary signs of infection.
• 18:26
  Dr. Jessica Yearwood: So inflammatory or white blood cells within the urine, blood, the presence of bacteria.
• 18:32
  Dr. Jessica Yearwood: Some other, chemical reactions that may be positive, like leukocyte esterase presence or nitrite presence.
• 18:38
  Dr. Jessica Yearwood: And, we're treating based on symptoms and that urinalysis.
• 18:42
  Dr. Jessica Yearwood: The gold standard of, urinary tract infection is getting that urine culture.
• 18:46
  Dr. Jessica Yearwood: So seeing what bacteria actually grows out of the urine and what antibiotics, those bacteria are sensitive to.
• 18:53
  Dr. Jessica Yearwood: Those tests often take one or two, sometimes more, days to result.
• 18:57
  Dr. Jessica Yearwood: So we're often just treating on, symptoms or the results of the urinalysis.
• 19:02
  Dr. Jessica Yearwood: Those presenting symptoms can be very mild, to very, serious and complications of upper urinary tract infections, which is pyelonephritis or kidney infections.
• 19:13
  Dr. Jessica Yearwood: Yeah.
• 19:13
  Dr. Jessica Yearwood: And even systemic or whole body response to infection, which we call sepsis.
• 19:20
  Dr. Jessica Yearwood: If you are younger and healthier without a lot of underlying medical conditions, the likelihood that you'll have an uncomplicated urinary tract infection or UTI High, as you age, and have other medical conditions especially, if you are, elderly and, in a nursing home type of environment or, not able to really care for yourself.
• 19:42
  Dr. Jessica Yearwood: Very much higher risk of having those more complicated and serious infections.
• 19:47
  Dr. Komal Patil-Sisodia: Yeah.
• 19:48
  Dr. Komal Patil-Sisodia: I worked as a hospitalist for a bit and the number of older women who came in with u sepsis.
• 19:53
  Dr. Komal Patil-Sisodia: It can be life threatening and have a very high mortality for these women.
• 19:57
  Dr. Komal Patil-Sisodia: What tends to be your approach once you get all of these tests?
• 20:01
  Dr. Komal Patil-Sisodia: What does your conversation generally look like, with patients around this issue?
• 20:07
  Dr. Jessica Yearwood: several years ago I started, asking more questions, not just about the urinary tract infection, but if there was other underlying symptoms that they were experiencing.
• 20:16
  Dr. Jessica Yearwood: Are they having, vaginal dryness?
• 20:18
  Dr. Jessica Yearwood: Are they having, uncomfortable or painful, sexual activity?
• 20:22
  Dr. Jessica Yearwood: Are there other things pointing towards a broader, genital urinary syndrome of menopause having conversations about, why these urinary tract infections are occurring, asking them, are they happening after sexual activity?
• 20:35
  Dr. Jessica Yearwood: Are they, happening after, they have been sitting for long periods without emptying their bladder or when they have decreased, fluid intake, asking about incontinence and if they're wearing any, products for incontinence.
• 20:49
  Dr. Jessica Yearwood: Because, if you have, urine soaked incontinence products, sitting next to the, vulva and vagina where the urethra, opening is, you definitely are gonna have higher risk for having that bacteria be able to get up into the urethra, into the bladder and start to cause a problem.
• 21:06
  Dr. Jessica Yearwood: If they were answering yes to a lot of these questions, I was asking about, low dose topical vaginal estrogen use, and if anyone had ever spoken to them about that or did they know that might be beneficial?
• 21:19
  Dr. Jessica Yearwood: I found that, I was often the first person who had that conversation with them when I was seeing them for the first time at, two or three in the morning with symptoms.
• 21:28
  Dr. Jessica Yearwood: I started, talking to them and counseling initially about, Hey, maybe you want to talk to your doctor about this.
• 21:34
  Dr. Jessica Yearwood: And then I, had a turn in practice and I thought to myself, why am I not just prescribing this?
• 21:41
  Dr. Jessica Yearwood: They are in front of me right now.
• 21:42
  Dr. Jessica Yearwood: I know that it's going to be weeks or months before they get a primary care appointment.
• 21:47
  Dr. Jessica Yearwood: To follow up on this.
• 21:48
  Dr. Jessica Yearwood: And I just knew that it was so important.
• 21:51
  Dr. Jessica Yearwood: Now the guidelines have changed where this is first line treatment I think if you see something and you are asking the right questions and you know what the answer is to treat it, you really should ethically be having those conversations and prescribing the medication at the time you're seeing those patients.
• 22:09
  Dr. Komal Patil-Sisodia: I totally agree.
• 22:10
  Dr. Komal Patil-Sisodia: It's been lovely to see such a change in practice around this.
• 22:14
  Dr. Komal Patil-Sisodia: A lot of women were afraid to use vaginal estrogen'cause of what was written on the black box morning.
• 22:19
  Dr. Komal Patil-Sisodia: And we've had a great group of physicians go out there and advocate have that removed from the labeling of hormone products, I think that's good.
• 22:28
  Dr. Komal Patil-Sisodia: My hope is that we see more women, utilizing this therapy because sepsis is such a preventable death in older women.
• 22:35
  Dr. Komal Patil-Sisodia: And if we can do better by them from this regard, I think that's excellent.
• 22:39
  Dr. Komal Patil-Sisodia: So thank you for sharing your experience
• 22:42
  Dr. Jessica Yearwood: for, listeners, if you are someone who has been experiencing.
• 22:46
  Dr. Jessica Yearwood: Recurrent urinary tract infections.
• 22:47
  Dr. Jessica Yearwood: If you are having symptoms of vaginal dryness, painful, sexual activity.
• 22:52
  Dr. Jessica Yearwood: If you end up in the emergency department at two or three in the morning, ask about, vaginal, estrogen.
• 22:58
  Dr. Jessica Yearwood: Again, the, probably experience in education of our emergency medicine, providers is, might be a bit limited.
• 23:05
  Dr. Jessica Yearwood: But I think you do have to advocate yourself and I think that this is information that, should be getting to emergency medicine.
• 23:13
  Dr. Jessica Yearwood: Providers, several places are updating, their care guidelines to include, low dose topical vaginal estrogen as a treatment, with, recurrent urinary tract infections.
• 23:23
  Dr. Jessica Yearwood: the exposure to antibiotics, even if it's only a three day treatment, for an uncomplicated urinary tract infection, has potential for, cumulative, changes.
• 23:32
  Dr. Jessica Yearwood: It can disrupt your gut microbiome.
• 23:35
  Dr. Jessica Yearwood: It can put you right at increased risk for developing gastrointestinal related infections like Clostridium difficile, which is a horrible diarrheal illness.
• 23:43
  Dr. Jessica Yearwood: It's very difficult to treat.
• 23:45
  Dr. Jessica Yearwood: Also, development of resistant bacteria, may make it more difficult to treat other infections.
• 23:50
  Dr. Jessica Yearwood: In my practice I see people coming in who need, several days of iv, antibiotics to treat simple, urinary tract infections because the oral options, the pills that we have to treat them don't work anymore.
• 24:04
  Dr. Komal Patil-Sisodia: Yeah.
• 24:05
  Dr. Jessica Yearwood: These women are in their fifties, they're in their sixties.
• 24:07
  Dr. Jessica Yearwood: I find myself the first person having the conversation about, vaginal estrogen and treating the underlying problem.
• 24:13
  Dr. Jessica Yearwood: This is definitely a big deal.
• 24:15
  Dr. Jessica Yearwood: Emergency medicine providers, can have a really big impact.
• 24:19
  Dr. Komal Patil-Sisodia: That's fantastic.
• 24:20
  Dr. Komal Patil-Sisodia: You should go teach that honestly, because it will save a lot of lives.
• 24:24
  Dr. Komal Patil-Sisodia: So that's my 2 cents.
• 24:26
  Dr. Jessica Yearwood: I should do that because I emailed, cME when I got done with the Menopause Society, I, was looking at, the history.
• 24:32
  Dr. Jessica Yearwood: There's 15 years of CME stuff on there.
• 24:35
  Dr. Jessica Yearwood: There was nothing on menopause and perimenopause.
• 24:37
  Dr. Jessica Yearwood: I emailed and they wrote me back and they're planning something for January or February.
• 24:41
  Dr. Jessica Yearwood: I'm like, this needs to get out there.
• 24:44
  Dr. Jessica Yearwood: I would love to do that.
• 24:45
  Dr. Jessica Yearwood: You should do it.
• 24:46
  Dr. Jessica Yearwood: It really is not scary.
• 24:48
  Dr. Jessica Yearwood: It doesn't take a lot of time.
• 24:49
  Dr. Jessica Yearwood: And especially now with the black box warning, gone, there's no reason not to.
• 24:53
  Dr. Jessica Yearwood: Exactly.
• 24:53
  Dr. Komal Patil-Sisodia: Thank you so much for that great explanation hopefully, to all our listeners out there, you're hearing loud and clear what Dr.
• 24:59
  Dr. Komal Patil-Sisodia: Yearwood is saying about making sure that you are talking to your doctor, especially if you're having these recurrent infections.
• 25:06
  Dr. Komal Patil-Sisodia: If you're lucky enough to run into somebody like Dr.
• 25:09
  Dr. Komal Patil-Sisodia: Yearwood who is going to prescribe that for you, all the better.
• 25:12
  Dr. Komal Patil-Sisodia: My hope is that, we're able to impact enough, er healthcare providers to start doing this without fear of, the hormones potentially causing further issues.
• 25:21
  Dr. Komal Patil-Sisodia: Let's move on to the musculoskeletal system.
• 25:24
  Dr. Komal Patil-Sisodia: One of the most common complaints I see coming into my office is joint pain, stiffness, frozen shoulder, and then as an endocrinologist, because I do a lot of osteoporosis, fractures.
• 25:35
  Dr. Komal Patil-Sisodia: So I'd love to talk through each of those with you, hear what your recommendations are, and then let's chat through that.
• 25:43
  Dr. Jessica Yearwood: I think, starting with fractures, that's a big one.
• 25:46
  Dr. Jessica Yearwood: That's bread and butter, emergency medicine, daily, complaint, hip fractures, wrist fractures, are huge.
• 25:53
  Dr. Jessica Yearwood: They're a complication of, osteopenia and osteoporosis, which is driven by the loss of estrogen.
• 26:01
  Dr. Jessica Yearwood: We reach our peak bone mass in, early thirties, and then start to have decline, and, really accelerated decline during that menopause, transition those few years around, the final menstrual period we're looking at, those fragility fractures, the ones that happen with lower impact, injuries.
• 26:19
  Dr. Jessica Yearwood: And, I think, there's prob whole different conversation about ma managing osteoporosis and osteopenia.
• 26:27
  Dr. Jessica Yearwood: The takeaway, is that these are potentially preventable.
• 26:31
  Dr. Jessica Yearwood: The problem is that we're often starting too late and identifying people at risk.
• 26:35
  Dr. Jessica Yearwood: And we're often starting too late, in treatment, or not initiating treatment once someone has one of these first, fragility fractures.
• 26:44
  Dr. Komal Patil-Sisodia: There's so much distrust of the medications that came out for osteoporosis treatment, like alendronate, all of these bisphosphonates and things like that.
• 26:52
  Dr. Komal Patil-Sisodia: When they first came out, people were starting them early and they weren't understanding that they shouldn't use them for more than five years in a row.
• 27:00
  Dr. Komal Patil-Sisodia: People were getting atypical fractures.
• 27:02
  Dr. Komal Patil-Sisodia: By the time a woman shows up in the ER with a fragility fracture, it's too late.
• 27:07
  Dr. Komal Patil-Sisodia: The studies for hormone therapy and menopause are so interesting because they gave women hormones for five years, saw a 20 to 40% reduction in fractures.
• 27:19
  Dr. Komal Patil-Sisodia: But when they took the hormones away, all of that effect went away.
• 27:22
  Dr. Komal Patil-Sisodia: So it was never approved for the treatment of osteoporosis only to prevent progression from osteopenia, which is weakening bone, to osteoporosis, where you're at higher risk for fracture.
• 27:33
  Dr. Komal Patil-Sisodia: I'm sure you see that a lot now in the er.
• 27:35
  Dr. Komal Patil-Sisodia: When you are getting imaging, for these patients with hip fractures are you seeing changes on the x-ray that indicate they may have thinning of their bones?
• 27:43
  Dr. Jessica Yearwood: A lot of the times the radiologists who are reading the fractures will comment, on, whether the bones look osteopenic or osteoporotic.
• 27:52
  Dr. Jessica Yearwood: But the education we get in emergency medicine isn't really guiding us, to call that out to patients.
• 28:00
  Dr. Jessica Yearwood: For people who are listening, the recommended age for DEXA screening is 65, maybe a little bit earlier if you have other risk factors.
• 28:08
  Dr. Jessica Yearwood: If you are under that age and have had, a significant fracture, wrist, hip, ankle, ask and make sure you are getting appropriate follow up, to identify, your bone density and where it's at so that you can start, intervening if osteopenia or osteoporosis is present, and, start, making those changes.
• 28:29
  Dr. Jessica Yearwood: If you haven't had a fracture, being aware with the loss of estrogen you gotta start early.
• 28:34
  Dr. Jessica Yearwood: Make sure your nutrition is, dialed in your vitamin D and calcium intake is appropriate and you're doing strength training or jump training to, maintain that bone, density.
• 28:44
  Dr. Jessica Yearwood: Even trying to build it if, you are a little bit behind, or have lower bone density, realizing who's at risk.
• 28:50
  Dr. Jessica Yearwood: If you are a thin person, under 127 pounds, is a risk factor, for, osteoporosis.
• 28:56
  Dr. Jessica Yearwood: If you, have Asian heritage, also another, risk factor.
• 29:00
  Dr. Jessica Yearwood: And then there's a lot of, metabolic, conditions and medical diagnoses or even medications that put you at risk.
• 29:05
  Dr. Jessica Yearwood: Steroids.
• 29:06
  Dr. Jessica Yearwood: Exactly.
• 29:07
  Dr. Jessica Yearwood: So just knowing that and, having the conversation with your, doctor, if they're not bringing it up, please feel empowered to ask questions.
• 29:16
  Dr. Komal Patil-Sisodia: As an endocrinologist, I know the US Preventative Services Task Force and the American College of Gynecology, say 65 and older, the Endocrine Society advocates for 50 and older if you have risk factors one of the things that I do is I will do it if there is early menopause in women.
• 29:33
  Dr. Komal Patil-Sisodia: All that time that passes that they're not getting evaluated, is important.
• 29:38
  Dr. Komal Patil-Sisodia: The American Diabetes Association put in their standards of care for people who have had diabetes for longer than 10 years.
• 29:46
  Dr. Komal Patil-Sisodia: They're at increased risk of fracture.
• 29:48
  Dr. Komal Patil-Sisodia: And what they found in their studies, and this was the other thing that just you're actually at increased risk for fracture, both with diabetes and without.
• 29:56
  Dr. Komal Patil-Sisodia: I kept thinking, how many years have I cast that off and not really thought about it, this was some newer data that came out.
• 30:02
  Dr. Komal Patil-Sisodia: There are some newer things that we're learning for all of our listeners that are mind blowing.
• 30:07
  Dr. Jessica Yearwood: Yeah, exactly.
• 30:09
  Dr. Jessica Yearwood: And then thinking about, people, that have other underlying medical conditions or obesity, if they do sustain a fracture it does require surgical repair, which, most hip and femur fractures, do, they are at increased risk for, complications, delayed wound healing, more difficult postoperative, courses as well.
• 30:28
  Dr. Jessica Yearwood: we know that even without increased, risk those who sustain hip fractures are at increased risk of dying, within the first year after that fracture.
• 30:38
  Dr. Jessica Yearwood: Increased risk for not returning to baseline functioning.
• 30:43
  Dr. Jessica Yearwood: Maybe not even getting out of the nursing home, this is something that's near and dear to me.
• 30:48
  Dr. Jessica Yearwood: I watched, my grandmother, go through two hip fractures, within a few years.
• 30:54
  Dr. Jessica Yearwood: To see the acceleration of her cognitive and functional decline, after those, injuries and, surgeries massive witness.
• 31:03
  Dr. Jessica Yearwood: Transitioning back to the urinary tract infections.
• 31:05
  Dr. Jessica Yearwood: She, ended up in the, emergency department and hospitalized for recurrent urinary tract infections, in conjunction with some complications.
• 31:14
  Dr. Jessica Yearwood: In her eighties when these things were happening, but, I've seen this happen to women who have been much younger, really does have a huge impact on, potential for quality of life quantity of life, once you have a major fracture.
• 31:27
  Dr. Komal Patil-Sisodia: I would agree.
• 31:28
  Dr. Komal Patil-Sisodia: It's such a common story, and I'm glad you brought up the connection to the UTIs, if the TI gets bad enough and somebody gets dehydrated and dizzy, they're gonna be at a higher risk for a fall and a fracture.
• 31:39
  Dr. Komal Patil-Sisodia: Exactly.
• 31:39
  Dr. Komal Patil-Sisodia: And a lot of times we see the two coming in together and that is a high risk scenario for anybody dealing with both that's a great point.
• 31:48
  Dr. Komal Patil-Sisodia: I'm sorry to hear about your grandma.
• 31:49
  Dr. Komal Patil-Sisodia: It's always hard when it's the people we love that we're watching go through all of this.
• 31:54
  Dr. Jessica Yearwood: I think it also gives you perspective about what your patients are going through and what they've gone through.
• 32:00
  Dr. Jessica Yearwood: And, an ability to provide, guidance on maybe what to expect and questions to ask along the way.
• 32:06
  Dr. Jessica Yearwood: I feel like some of these things, that have happened in my personal life have made me even more, adamant about being able to tell people and empower them, with these conditions.
• 32:18
  Dr. Komal Patil-Sisodia: Yeah.
• 32:19
  Dr. Komal Patil-Sisodia: I have such empathy for our mothers and the generations that didn't get the option of hormone therapy.
• 32:26
  Dr. Komal Patil-Sisodia: I think about this all the time, is how different would their quality have life been had they been given these options?
• 32:32
  Dr. Komal Patil-Sisodia: So no.
• 32:32
  Dr. Komal Patil-Sisodia: And I don't think we'll ever have that answer, but, we can do better by all of the women in the subsequent generations.
• 32:39
  Dr. Komal Patil-Sisodia: Let's, switch gears to, vasomotor symptoms, anxiety and neuropsychiatric symptoms of menopause.
• 32:46
  Dr. Komal Patil-Sisodia: You must see quite a bit of that because those symptoms can be mistaken for other things.
• 32:51
  Dr. Komal Patil-Sisodia: I'd love to hear your experience with that
• 32:54
  Dr. Jessica Yearwood: hot flashes and hot flushes, I am 46, I am perimenopausal.
• 32:58
  Dr. Jessica Yearwood: I, have some occasional warmth and, feeling, that I'm experiencing.
• 33:04
  Dr. Jessica Yearwood: I haven't personally experienced, a major hot flash or hot flush yet.
• 33:08
  Dr. Jessica Yearwood: From descriptions and what people have shared, the first time it happens, it can be pretty, scary and pretty uncomfortable to all of a sudden start feeling hot and sweaty, and actually having physical perspiration, which may or may not be associated with palpitations.
• 33:25
  Dr. Jessica Yearwood: If your, sympathetic nervous system gets revved up and you start to feel anxious, have breathing trouble.
• 33:31
  Dr. Jessica Yearwood: You could think something serious is going on.
• 33:33
  Dr. Jessica Yearwood: You could be concerned about a heart attack, or, some other major medical issue that could land you in the emergency department.
• 33:40
  Dr. Jessica Yearwood: Maybe you would feel, different if you're sitting in the waiting room and go, oh my gosh why am I here?
• 33:46
  Dr. Jessica Yearwood: Maybe the experience isn't great when you come in tell your story get some tests done and everything's fine.
• 33:52
  Dr. Jessica Yearwood: And, the person who's seeing you maybe doesn't recognize that was a hot flash and doesn't give you that.
• 33:58
  Dr. Jessica Yearwood: Possibility or education.
• 34:00
  Dr. Jessica Yearwood: You might walk away going, maybe I shouldn't have come in.
• 34:03
  Dr. Jessica Yearwood: Or, what's wrong with me?
• 34:04
  Dr. Jessica Yearwood: Something felt really bad and they said everything is fine, and then maybe it happens again.
• 34:09
  Dr. Jessica Yearwood: And you're thinking, do I go back to the emergency department again?
• 34:13
  Dr. Jessica Yearwood: They told me everything's fine, but everything doesn't feel fine.
• 34:16
  Dr. Jessica Yearwood: Recognizing that is a symptom that can, occur for a lot of people.
• 34:21
  Dr. Jessica Yearwood: It's hard to say, don't go to the emergency department or don't be evaluated when you have new symptoms.
• 34:26
  Dr. Jessica Yearwood: I think you absolutely should.
• 34:29
  Dr. Jessica Yearwood: But for the people who are listening, if that's happening, be mindful of that, and you might have to bring it up as a possibility that this was a hot flash.
• 34:38
  Dr. Komal Patil-Sisodia: I think that's a great point.
• 34:39
  Dr. Komal Patil-Sisodia: If this is a pattern you're going in, every time you're feeling terrible and nobody's able to give you answers talking to your primary or somebody who is a menopause aware healthcare provider is probably going to get you the most bang for your buck.
• 34:53
  Dr. Komal Patil-Sisodia: I haven't had a hot flash yet in perimenopause, but I remember after giving birth to my son, we were living on the east coast at the time, and it was 18 degrees in Baltimore the pregnancy hormones just make you feel so hot, I rolled into the hospital in a sweater, didn't have a coat gave birth, went home a few days later and the hot flashes that came postpartum.
• 35:15
  Dr. Komal Patil-Sisodia: Oh my gosh, right?
• 35:16
  Dr. Komal Patil-Sisodia: It's a low
• 35:17
  Dr. Jessica Yearwood: estrogen state.
• 35:18
  Dr. Komal Patil-Sisodia: It is.
• 35:19
  Dr. Komal Patil-Sisodia: And I had such empathy for my menopausal patients, it was so bad that I had.
• 35:25
  Dr. Komal Patil-Sisodia: The windows open and the fan on, and it was 18 degrees.
• 35:29
  Dr. Komal Patil-Sisodia: My husband was like, I'm taking our kid and going to the other room'cause we're both gonna die in here but it was impactful.
• 35:35
  Dr. Komal Patil-Sisodia: I think people underestimate how severe it can be for some women.
• 35:40
  Dr. Komal Patil-Sisodia: Some women are, lucky and barely feel anything and move on.
• 35:43
  Dr. Komal Patil-Sisodia: But there are some who really have those persistent hot flashes.
• 35:47
  Dr. Komal Patil-Sisodia: Another pattern I see in my practice is that women will go through menopause, have their hot flashes, everything will calm down.
• 35:56
  Dr. Komal Patil-Sisodia: Then 10 years later, they come back in their seventies or eighties and I'm ruling them out for adrenaline producing tumors.
• 36:03
  Dr. Komal Patil-Sisodia: It generally has always come back negative with the exception of one patient in the last 16 years.
• 36:09
  Dr. Komal Patil-Sisodia: To me that sounds miserable.
• 36:10
  Dr. Komal Patil-Sisodia: I can't imagine being in my seventies or eighties and having hot flashes.
• 36:14
  Dr. Jessica Yearwood: I think you make a really good point.
• 36:16
  Dr. Jessica Yearwood: If you are post-menopausal and you start having symptoms again, it is very important to exclude new diagnoses.
• 36:24
  Dr. Jessica Yearwood: A hot, flush and sweating associated with nausea with or without chest discomfort or difficulty breathing, could represent a cardiovascular event or a myocardial infarction.
• 36:36
  Dr. Jessica Yearwood: We know that presents differently in women I can't tell you the number of times I have, looked at an EKG, handed to me from, the waiting room.
• 36:44
  Dr. Jessica Yearwood: Someone has come in with nausea and sweating.
• 36:47
  Dr. Jessica Yearwood: And it's an actual heart attack.
• 36:49
  Dr. Jessica Yearwood: You need to get the person, in front of the cardiologist in the cath lab to open up a blocked vessel.
• 36:55
  Dr. Jessica Yearwood: The majority of those are, women, patients.
• 36:58
  Dr. Jessica Yearwood: That's so interesting.
• 36:59
  Dr. Jessica Yearwood: So are those types of heart attacks, those inferior myocardial infarctions, present.
• 37:03
  Dr. Jessica Yearwood: Not necessarily with a lot of chest pain, but more of autonomic symptoms.
• 37:07
  Dr. Jessica Yearwood: So the sweating, the nausea, the low blood pressure, maybe some epigastric discomfort.
• 37:12
  Dr. Jessica Yearwood: When you are having new symptoms, that have come up after being symptom free for a long time, you need to make sure that nothing else is going on.
• 37:21
  Dr. Jessica Yearwood: Something new, thyroid or something, metabolic, is happening.
• 37:24
  Dr. Komal Patil-Sisodia: Yeah.
• 37:24
  Dr. Komal Patil-Sisodia: Let's move on to the reproductive and gynecologic system.
• 37:28
  Dr. Komal Patil-Sisodia: I am sure that you see a lot of women coming in with, issues in this particular arena, like bleeding after they've already gone through menopause or heavy or prolonged bleeding during perimenopause.
• 37:41
  Dr. Komal Patil-Sisodia: So can you talk a little bit about that?
• 37:43
  Dr. Jessica Yearwood: Yeah.
• 37:44
  Dr. Jessica Yearwood: Abnormal bleeding, is a really common thing that brings, women into the emergency department.
• 37:49
  Dr. Jessica Yearwood: I think it's one of those things that, probably gets pushed off as not being super serious, because everyone's okay, it's menstrual period.
• 37:57
  Dr. Jessica Yearwood: What do you want us to do about it?
• 37:59
  Dr. Jessica Yearwood: I think, is the attitude that a lot of people have.
• 38:02
  Dr. Jessica Yearwood: But I think you have to approach this, as a clinician, really thoughtfully and, ensuring that nothing serious is going on.
• 38:09
  Dr. Jessica Yearwood: We know that during the menopause transition, perimenopause, hormones are.
• 38:13
  Dr. Jessica Yearwood: Erratic and chaotic, and you are getting really high spikes of estrogen sometimes.
• 38:19
  Dr. Jessica Yearwood: You're having, ovulatory cycles that produce a second ovulation we call those loop cycles or luteal out of phase cycles.
• 38:27
  Dr. Jessica Yearwood: Your estrogen is getting higher stacking, your endometrial lining is, getting thicker, responding to that estrogen.
• 38:33
  Dr. Jessica Yearwood: Estrogen causes the endometrial lining inside the uterus, to grow.
• 38:37
  Dr. Jessica Yearwood: Progesterone stabilizes it, and when both of those drop, when there's, no baby during a normal cycle, that's, made, right the uterine lighting sheds and you have your period.
• 38:47
  Dr. Jessica Yearwood: And that cycle gets really disruptive.
• 38:49
  Dr. Jessica Yearwood: We start having more anovulatory cycles eggs aren't being, released from the ovary, which causes those hormonal changes to happen.
• 38:57
  Dr. Jessica Yearwood: A lot of people will have, structural, problems, within the uterus.
• 39:00
  Dr. Jessica Yearwood: So fibroids, which are a big, problem for bleeding.
• 39:03
  Dr. Jessica Yearwood: As we get older and have more medical conditions, maybe we're on medications, have had blood clots in the lungs or legs, pulmonary embolism or DBTs, and have been put on, anticoagulation or blood thinning medications or they're on aspirin increasing their risk for bleeding at baseline.
• 39:19
  Dr. Jessica Yearwood: Your periods can start to be longer.
• 39:21
  Dr. Jessica Yearwood: They can start to be, heavier.
• 39:23
  Dr. Jessica Yearwood: You can start to pass clots when you didn't used to.
• 39:25
  Dr. Jessica Yearwood: You can start to have pelvic pain when you didn't use to.
• 39:29
  Dr. Jessica Yearwood: You may be bleeding and thinking, oh my God, I'm losing so much blood.
• 39:33
  Dr. Jessica Yearwood: Some people will start to have dizziness or lightheadedness, with it.
• 39:36
  Dr. Jessica Yearwood: It's also really disruptive to life.
• 39:39
  Dr. Jessica Yearwood: It is very hard to work or, manage other people in your life, when you are having to change a pad or a tampon every hour, sometimes for days in a row.
• 39:49
  Dr. Jessica Yearwood: I think I've really changed my perspective over the years in terms of how I approach these women.
• 39:54
  Dr. Jessica Yearwood: Really starting out with, you get the details of what's going on, but asking them what are they worried about?
• 40:00
  Dr. Jessica Yearwood: What is bothersome, what really brought them in.
• 40:03
  Dr. Jessica Yearwood: We're evaluating for the development of a low blood count or anemia, so we're checking blood counts.
• 40:09
  Dr. Jessica Yearwood: In the perimenopause or premenopausal patient, we're ruling out pregnancy because bleeding can be a sign of a pregnancy in the wrong spot.
• 40:16
  Dr. Jessica Yearwood: So an ectopic pregnancy, which, is, potentially a life-threatening, emergency, or a miscarriage.
• 40:22
  Dr. Jessica Yearwood: We're doing a pregnancy test.
• 40:24
  Dr. Jessica Yearwood: We may be doing an ultrasound in the emergency department to look for any big structural, abnormalities that might be contributing to the bleeding.
• 40:31
  Dr. Jessica Yearwood: Most patients, are having really symptomatic, issues.
• 40:35
  Dr. Jessica Yearwood: But for the most part, blood counts are usually stable or maybe a little bit lower.
• 40:40
  Dr. Jessica Yearwood: Most women probably have a very not satisfying experience, with this complaint when they come to the emergency department.
• 40:46
  Dr. Jessica Yearwood: Because we tell them there's not a whole lot we can do.
• 40:49
  Dr. Jessica Yearwood: We often consult with our, gynecology, colleagues and, talk about what we might be able to do to help regulate cycles, whether that's oral contraceptive pills to suppress, their own chaotic, hormones.
• 41:03
  Dr. Jessica Yearwood: Whether that's high doses of, a progesterone product to stabilize the uterine lining.
• 41:08
  Dr. Jessica Yearwood: There's really no quick fix for this.
• 41:10
  Dr. Jessica Yearwood: It does take time to sort through what's going on.
• 41:14
  Dr. Jessica Yearwood: The, big takeaway for our listeners is, if you have a concern about bleeding, you should go in, we need to rule out, anemia, pregnancy, but then to, understand that really getting at the treatment and the management is gonna take some time to sort out exactly what is going on.
• 41:33
  Dr. Jessica Yearwood: Is this too much estrogen?
• 41:35
  Dr. Jessica Yearwood: Is it not enough progesterone?
• 41:38
  Dr. Jessica Yearwood: Is it something structural?
• 41:40
  Dr. Jessica Yearwood: Understanding what we can do within the emergency department.
• 41:43
  Dr. Jessica Yearwood: The next steps are following up with, your gynecologist or primary care provider for treatment options.
• 41:49
  Dr. Komal Patil-Sisodia: I can attest to how scary this is because when I was in my thirties, we were struggling with, secondary infertility.
• 41:56
  Dr. Komal Patil-Sisodia: I had endometriosis and one of these episodes where the bleeding was like, am I going to bleed out and die?
• 42:04
  Dr. Komal Patil-Sisodia: It's terrifying, and you're right.
• 42:05
  Dr. Komal Patil-Sisodia: There was not a lot they could do for me other than make sure I wasn't having a miscarriage made sure my blood counts were stable, it was probably one of the most terrifying experiences I've had in my life.
• 42:19
  Dr. Komal Patil-Sisodia: Absolutely.
• 42:19
  Dr. Komal Patil-Sisodia: It takes a while to get everything sorted through, but I really appreciate, and I know patients who come across you will appreciate the approach you take with them.
• 42:29
  Dr. Komal Patil-Sisodia: That is, gentle and filled with explanations.
• 42:32
  Dr. Komal Patil-Sisodia: Thank you for doing that.
• 42:34
  Dr. Jessica Yearwood: Oh Absolutely.
• 42:34
  Dr. Jessica Yearwood: Most people are usually fine and okay.
• 42:37
  Dr. Jessica Yearwood: But I have also taken care of women who I have had to admit for blood transfusions, because things had been going on for so long that, they weren't getting appropriate treatment and intervention.
• 42:49
  Dr. Jessica Yearwood: Their red blood cell counts were in critically low, levels.
• 42:53
  Dr. Jessica Yearwood: Some of the signs that your blood counts are critically low, you can take and pull down your eye and look at the lining of your conjunctiva.
• 43:00
  Dr. Jessica Yearwood: It should be nice and pink.
• 43:02
  Dr. Jessica Yearwood: If it's really white and pale, that usually means your blood count is very low.
• 43:06
  Dr. Jessica Yearwood: Symptoms of fatigue.
• 43:08
  Dr. Jessica Yearwood: You're doing your normal activities, climbing upstairs, cleaning your house, playing with your children, walking your dog, and you're more fatigued or tired or short of breath, or very dizzy or lightheaded.
• 43:20
  Dr. Jessica Yearwood: And low blood pressure also go along with having those low blood counts.
• 43:24
  Dr. Jessica Yearwood: So if you're having bleeding plus any of those symptoms, you definitely should be evaluated, with that blood count.
• 43:31
  Dr. Komal Patil-Sisodia: Thank you so much Jessica.
• 43:33
  Dr. Komal Patil-Sisodia: I appreciate the time you took with me and all of our listeners to go through all of these things that you're seeing come through the er.
• 43:40
  Dr. Komal Patil-Sisodia: Anybody who comes across you is so lucky, to be under your care and the fact that you're looking at them from such a compassionate and knowledgeable lens.
• 43:49
  Dr. Komal Patil-Sisodia: I don't know many ER doctors who are menopause society certified practitioners as well, so that's really remarkable.
• 43:56
  Dr. Komal Patil-Sisodia: I'd love for you to tell our listeners, about your new clinic that you are opening up and where you're going to be located.
• 44:04
  Dr. Komal Patil-Sisodia: I was really excited when you told me that you will be, opening up your own, menopause clinic and I wanted to make sure everybody knew about it so they could potentially go see you for their menopause care.
• 44:16
  Dr. Jessica Yearwood: Thank you.
• 44:17
  Dr. Jessica Yearwood: This is something that I am super, excited about.
• 44:20
  Dr. Jessica Yearwood: I saw this gap in care as I was getting the training and knowledge for myself, I started to think I'm having these conversations with women in emergent.
• 44:31
  Dr. Jessica Yearwood: Settings and I can't really do a whole lot, in the structure of, emergency medicine, visit.
• 44:37
  Dr. Jessica Yearwood: And, so I, yeah, I decided that, I wanted to open a practice where I could, do some consultative and, direct care for women in perimenopause and menopause.
• 44:48
  Dr. Jessica Yearwood: Hopefully if everything's on track, I'll be ready in December to start seeing patients.
• 44:54
  Dr. Jessica Yearwood: My, practice is gonna be located in Gig Harbor, here in Washington.
• 44:58
  Dr. Jessica Yearwood: So South Sound.
• 44:59
  Dr. Jessica Yearwood: I will be, having some telehealth, availability as well.
• 45:03
  Dr. Jessica Yearwood: I think for right now, I'd love to see my new patients in person.
• 45:07
  Dr. Jessica Yearwood: I think that's a great way to get to know people, and start talking about things.
• 45:11
  Dr. Jessica Yearwood: But we'll see if I open up the telehealth to new patients as well.
• 45:14
  Dr. Jessica Yearwood: We'll see what kind of interest, and need there is, for that option.
• 45:17
  Dr. Komal Patil-Sisodia: There's a huge need.
• 45:18
  Dr. Komal Patil-Sisodia: I predict you'll be busy very soon.
• 45:20
  Dr. Komal Patil-Sisodia: What is the name of your practice?
• 45:22
  Dr. Jessica Yearwood: The name of my practice right now is Jessica Yearwood, md pLLC.
• 45:27
  Dr. Jessica Yearwood: I'll have my website up and running soon.
• 45:30
  Dr. Jessica Yearwood: You can, get that out to the listeners if they're interested in contacting me, see where I am, see what I'm about.
• 45:35
  Dr. Komal Patil-Sisodia: That would be fantastic.
• 45:36
  Dr. Komal Patil-Sisodia: And are you on social media, Instagram, TikTok, and, what are your handles for that?
• 45:41
  Dr. Jessica Yearwood: I am on, Instagram right now and it's, Jessica Yearwood, md.
• 45:46
  Dr. Jessica Yearwood: You can look me up and, really, as, as a midlife women myself, the social media thing is, certainly challenging.
• 45:53
  Dr. Jessica Yearwood: but very fun.
• 45:54
  Dr. Jessica Yearwood: I, don't have a lot of content on there, but what I do hope to put on there is educational things.
• 46:00
  Dr. Jessica Yearwood: I also have a passion for empowering people to, navigate the medical system making visits with your, primary care or specialty doctor really work for you.
• 46:10
  Dr. Jessica Yearwood: Educating, what questions to ask how to get through your concerns.
• 46:14
  Dr. Jessica Yearwood: There are so many knowledgeable people out there doing such good work, on social media.
• 46:20
  Dr. Jessica Yearwood: I love finding things that people have done reposting resharing and, directing, patients, to those sites so they can, be informed as well.
• 46:29
  Dr. Komal Patil-Sisodia: Yeah.
• 46:29
  Dr. Komal Patil-Sisodia: That is fantastic and I'm so excited that, we reconnected and I get to call you a colleague and I'm really looking forward to working with you in this space.
• 46:39
  Dr. Komal Patil-Sisodia: Thank you for taking the time today.
• 46:41
  Dr. Jessica Yearwood: Absolutely.
• 46:42
  Dr. Jessica Yearwood: Thank you for, starting this podcast.
• 46:44
  Dr. Jessica Yearwood: When I came across it, scrolling through social media, I went, oh my gosh, I know her like this.
• 46:50
  Dr. Jessica Yearwood: Yeah.
• 46:51
  Dr. Jessica Yearwood: I kinda start listening to this and, I just, I find that it is, easily digestible information.
• 46:57
  Dr. Jessica Yearwood: You can turn it on in the car.
• 46:59
  Dr. Jessica Yearwood: Put it on your headphones when you're cleaning your house.
• 47:01
  Dr. Jessica Yearwood: It's really insightful relevant information, that, everyone, is going to benefit from.
• 47:07
  Dr. Jessica Yearwood: So thank you for doing this.
• 47:09
  Dr. Komal Patil-Sisodia: Oh, thank you so much.
• 47:10
  Dr. Komal Patil-Sisodia: That's very kind of you.
• 47:12
  Dr. Komal Patil-Sisodia: To all of our listeners.
• 47:13
  Dr. Komal Patil-Sisodia: I will be linking all of Dr.
• 47:14
  Dr. Komal Patil-Sisodia: Yearwood information, including her new practice in the show notes for this episode.
• 47:20
  Dr. Komal Patil-Sisodia: Please make sure you go over to Instagram and follow her at Jessica Yearwood md and we will see you on the next episode.