Latest / Clearly Hormonal / Ep 02: Mother Nature is Not a Feminist

Transcript

Ep 02: Mother Nature is Not a Feminist · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Patil Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health, and recharge the conversations you are having with your healthcare providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:29
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your healthcare provider at your next visit.
• 0:39
  Dr. Komal Patil-Sisodia: Hi everyone, I'm Dr.
• 0:40
  Dr. Komal Patil-Sisodia: Komal Patil Sisodia.
• 0:41
  Dr. Komal Patil-Sisodia: Thank you so much for joining me for the second episode of Reset Recharge.
• 0:46
  Dr. Komal Patil-Sisodia: Today we are going to talk about the natural history of aging in women and why I think Mother Nature is not a feminist.
• 0:53
  Dr. Komal Patil-Sisodia: And this is not really the most uplifting topic of the podcast, but I think it's important information for all of us to know as we start advocating for our health when we're meeting with our healthcare providers.
• 1:06
  Dr. Komal Patil-Sisodia: So what are the main takeaways that I want you to walk away with today?
• 1:10
  Dr. Komal Patil-Sisodia: One, I want you to understand what happens with your hormones and how your different parts work, meaning your pituitary gland, your ovaries, your uterus.
• 1:22
  Dr. Komal Patil-Sisodia: What are the different hormone changes that are happening throughout the course of your lifetime number two?
• 1:28
  Dr. Komal Patil-Sisodia: what happens when our hormones, uh, start shifting in midlife.
• 1:33
  Dr. Komal Patil-Sisodia: That I think is really important because that's really where we start to see symptoms.
• 1:37
  Dr. Komal Patil-Sisodia: And the third thing that we're going to go through are what are the metabolic changes that are starting to happen when we hit midlife.
• 1:43
  Dr. Komal Patil-Sisodia: And I think that's really, those are the three main points.
• 1:46
  Dr. Komal Patil-Sisodia: If you walk away with an understanding of that, we have done our job on this episode.
• 1:51
  Dr. Komal Patil-Sisodia: So now we will launch into what you need to know about reproductive health.
• 1:55
  Dr. Komal Patil-Sisodia: I think the most important thing for women to know is that we are born with a set number of eggs So when we are itty bitty tiny fetuses in the uterus, in medicine we call it in utero, so if I say that, that's what I mean.
• 2:12
  Dr. Komal Patil-Sisodia: We are, we don't have fully formed reproductive organs yet, that's really where they start developing.
• 2:18
  Dr. Komal Patil-Sisodia: The ovaries will start developing follicles and by week 20 in utero we will have fully formed reproductive systems.
• 2:27
  Dr. Komal Patil-Sisodia: And at that point we have six to seven million eggs in our ovaries.
• 2:31
  Dr. Komal Patil-Sisodia: That's it.
• 2:32
  Dr. Komal Patil-Sisodia: That's what you're born with.
• 2:33
  Dr. Komal Patil-Sisodia: And the crazy part is that by the time we are born, that number has declined to one to three million.
• 2:40
  Dr. Komal Patil-Sisodia: So even before we get out into the world, our ovary count, our egg count has dropped pretty significantly.
• 2:47
  Dr. Komal Patil-Sisodia: So I want you to walk away with that little nugget there.
• 2:51
  Dr. Komal Patil-Sisodia: So then they continue to decline through the course of our life.
• 2:54
  Dr. Komal Patil-Sisodia: And by the time we hit our menstrual periods, our average egg count is around 400, 000.
• 3:01
  Dr. Komal Patil-Sisodia: It's wild to think about.
• 3:02
  Dr. Komal Patil-Sisodia: And by the time we are in our thirties, it is, it has declined into the 100, 000 range.
• 3:08
  Dr. Komal Patil-Sisodia: So you can see that Fertility declines over a period of time, and menopause happens when we run out of eggs.
• 3:15
  Dr. Komal Patil-Sisodia: That's traditionally how it's been defined.
• 3:18
  Dr. Komal Patil-Sisodia: I think it's a little bit more complicated and nuanced than that.
• 3:21
  Dr. Komal Patil-Sisodia: Um, but that is generally the way that we describe it to most people.
• 3:25
  Dr. Komal Patil-Sisodia: So, starting with an egg count of 6 7 million, decreasing while we're in utero, decreasing throughout our lifetime, and bottoming out when we hit menopause.
• 3:36
  Dr. Komal Patil-Sisodia: The ovaries are controlled by a gland in your brain that I call the remote control of most of your endocrine organs.
• 3:44
  Dr. Komal Patil-Sisodia: And that's our pituitary gland.
• 3:45
  Dr. Komal Patil-Sisodia: It is located directly in the center of your brain between your eyes.
• 3:51
  Dr. Komal Patil-Sisodia: And it sends signals to various different endocrine organs, including your thyroid, your adrenal glands, your ovaries.
• 3:59
  Dr. Komal Patil-Sisodia: For men, it sends signals to the testes in order to produce the hormones that each of these glands are responsible for.
• 4:07
  Dr. Komal Patil-Sisodia: So what happens in a regular menstrual cycle, once we start hitting our periods, is that the signals from the brain that we call FSH and LH will cause different changes in the union of our uterus.
• 4:20
  Dr. Komal Patil-Sisodia: cause ovulation of eggs, and then if we have a fertilized egg that implants, that goes on to develop into a pregnancy.
• 4:28
  Dr. Komal Patil-Sisodia: If we don't, then you just have another menstrual period and the cycle starts again.
• 4:33
  Dr. Komal Patil-Sisodia: So to delve into the cycle a little bit more, I think it's important for women to understand that in science we look at cycles based on 28 days, knowing that not everybody's cycle is 28 days.
• 4:44
  Dr. Komal Patil-Sisodia: So.
• 4:45
  Dr. Komal Patil-Sisodia: For the purposes of demonstrating this, I'm going to stick to the normal explanation of 28 days, but know that there can be variation in your cycles.
• 4:53
  Dr. Komal Patil-Sisodia: So the first phase of the menstrual cycles are called your follicular phase.
• 5:00
  Dr. Komal Patil-Sisodia: And that is where, for the first five to seven days, you're having your menstrual period.
• 5:05
  Dr. Komal Patil-Sisodia: And after that, the estrogen starts to rise, and FSH and LH, which are the signals from the pituitary gland, and they stand for follicle stimulating hormone and luteinizing hormone, those start to rise over time.
• 5:19
  Dr. Komal Patil-Sisodia: And the whole reason estrogen is rising is because it's trying to prepare the lining of the uterus in case there is an egg that gets fertilized and implants.
• 5:29
  Dr. Komal Patil-Sisodia: And so towards day 14 of the cycle, which is the midpoint, theoretically, where most women ovulate, uh, what we see is that the LH and the FSH spike up.
• 5:41
  Dr. Komal Patil-Sisodia: The ovarian follicles will release an egg.
• 5:45
  Dr. Komal Patil-Sisodia: And if that egg gets fertilized, then it will implant.
• 5:48
  Dr. Komal Patil-Sisodia: And in the second half of the menstrual cycle, which we call the luteal phase, what happens is the progesterone starts to rise because it needs to prepare that lining for the potential of a fertilized egg.
• 6:00
  Dr. Komal Patil-Sisodia: And so it does that by making it a more hospitable environment.
• 6:04
  Dr. Komal Patil-Sisodia: And if the egg is fertilized and implants, then the progesterone continues to rise and you will theoretically go into a pregnancy.
• 6:13
  Dr. Komal Patil-Sisodia: But if it doesn't, then the progesterone level drops and that lining starts shedding at the end of that next 14 day period, which is the first day of the subsequent cycle, which is the menstrual period.
• 6:25
  Dr. Komal Patil-Sisodia: So that is how overall those cycles work.
• 6:29
  Dr. Komal Patil-Sisodia: And if you think about it, We go through more hormonal shifts in one month than we can even fathom, right?
• 6:36
  Dr. Komal Patil-Sisodia: I mean, I just talked about four hormones going up and down.
• 6:40
  Dr. Komal Patil-Sisodia: We didn't even really touch on the fact that ovaries produce testosterone because we haven't really studied what that does in women effectively.
• 6:48
  Dr. Komal Patil-Sisodia: So I think it's important to understand that piece of it.
• 6:52
  Dr. Komal Patil-Sisodia: We are constantly going through hormonal shifts and then you throw pregnancy and postpartum period into the mix and it's even more hormonal shifts.
• 7:01
  Dr. Komal Patil-Sisodia: What happens as our eggs decline over our lifetime is at some point they bottom out and that is when we hit what's called midlife, interchangeably used as perimenopause transition, when your periods stop, that's called menopause.
• 7:16
  Dr. Komal Patil-Sisodia: But that, in that entire, uh, section of your life, things start to shift even more.
• 7:22
  Dr. Komal Patil-Sisodia: So I think it's important to understand now.
• 7:25
  Dr. Komal Patil-Sisodia: what's happening to the estrogen and progesterone levels.
• 7:29
  Dr. Komal Patil-Sisodia: And what we see is that as the egg counts decline, the estrogen levels and the progesterone levels also start to decline and menstrual cycles become more irregular because you don't have enough of those hormones to do what they were doing when you were having periods.
• 7:45
  Dr. Komal Patil-Sisodia: And then eventually they bottom out and things just stop flowing.
• 7:50
  Dr. Komal Patil-Sisodia: No pun intended.
• 7:51
  Dr. Komal Patil-Sisodia: Sorry.
• 7:51
  Dr. Komal Patil-Sisodia: That was really bad.
• 7:52
  Dr. Komal Patil-Sisodia: Um, Sorry, I have to get over myself there for a second.
• 7:58
  Dr. Komal Patil-Sisodia: Okay, we might leave that in there for your enjoyment.
• 8:09
  Dr. Komal Patil-Sisodia: We'll put it at the end for bloopers.
• 8:12
  Dr. Komal Patil-Sisodia: Okay, so now that we have walked through what you need to know about your reproductive parts, the basics, the hormonal shifts, not all of it, because it's a much more complicated nuance thing than I'm simplifying it to.
• 8:28
  Dr. Komal Patil-Sisodia: And we're going to build this in stages through each of the different episodes.
• 8:32
  Dr. Komal Patil-Sisodia: Um, now we also know what's happening to our hormones in midlife and what defines that midlife period in general terms.
• 8:41
  Dr. Komal Patil-Sisodia: Now I want you to get an understanding of what are the metabolic changes that start happening during that phase of our life.
• 8:48
  Dr. Komal Patil-Sisodia: So The way that I describe it to my patients is that if you look at this purely from a biologic or Mother Nature perspective, when we are not reproducing consistently, we're not contributing to the gene pool.
• 9:03
  Dr. Komal Patil-Sisodia: So Mother Nature sees us as not really helping her out, and when our estrogen and progesterone levels are declining, and likely our testosterone levels as well, she's ready to exit us out from the system.
• 9:16
  Dr. Komal Patil-Sisodia: Not really a happy thought.
• 9:18
  Dr. Komal Patil-Sisodia: And that's why I think she's not really a feminist.
• 9:20
  Dr. Komal Patil-Sisodia: If you look at all of the metabolic changes that start happening in that time period, we see that women start to lose their ability to hold on to muscle mass.
• 9:32
  Dr. Komal Patil-Sisodia: We start gaining fat mass, which, you know, everybody complains about.
• 9:36
  Dr. Komal Patil-Sisodia: You hear complaints about, oh, I'm gaining weight around my middle, I'm not as strong as I used to be.
• 9:42
  Dr. Komal Patil-Sisodia: Those are metabolic shifts that start tanking your metabolism.
• 9:45
  Dr. Komal Patil-Sisodia: We know through data and research that muscle mass is really important to maintain your basal metabolic rate.
• 9:53
  Dr. Komal Patil-Sisodia: So if these shifts in hormones cause you to lose your muscle mass, that's problematic.
• 9:58
  Dr. Komal Patil-Sisodia: And what we see happening after that is that blood pressure starts to go up.
• 10:03
  Dr. Komal Patil-Sisodia: Cholesterol starts to grow up, grow up, go up, grow up, go up.
• 10:08
  Dr. Komal Patil-Sisodia: Um, your, uh, uh, blood sugars will also start to go up.
• 10:13
  Dr. Komal Patil-Sisodia: And a lot of that is because when you gain weight around your middle, that extra fat tissue packs inside your abdominal cavity and doesn't just lay under your skin like it would on your arms or legs.
• 10:24
  Dr. Komal Patil-Sisodia: And what we've found that when there's fat inside the abdominal cavity, that's what we call visceral fat.
• 10:30
  Dr. Komal Patil-Sisodia: And that creates insulin resistance and blood sugars rise.
• 10:34
  Dr. Komal Patil-Sisodia: So what we're seeing is we have three things that are going to increase our risk of heart disease.
• 10:40
  Dr. Komal Patil-Sisodia: stroke and diabetes.
• 10:42
  Dr. Komal Patil-Sisodia: That's not really exciting.
• 10:44
  Dr. Komal Patil-Sisodia: The other thing that happens because we're losing muscle mass is that bone density starts to decline.
• 10:49
  Dr. Komal Patil-Sisodia: So our bones become more brittle and we are at increased risk for developing a fracture.
• 10:54
  Dr. Komal Patil-Sisodia: One of the worst statistics we have in medicine is that after the age of 75, if you sustain a hip fracture, if you fall and you break your hip, The mortality rate, meaning the rate of death from that hip fracture, can be as high as 50 percent depending on what your, what we call, functional status is, like how strong you are, how hardy you are, and I have seen many patients over the course of my career unfortunately meet their demise after going through a hip fracture.
• 11:22
  Dr. Komal Patil-Sisodia: So we try to be very proactive about managing that.
• 11:27
  Dr. Komal Patil-Sisodia: Um, in addition to that, because the list is not done yet, uh, women will also start having more difficulty sleeping at night either because they can't fall asleep or stay asleep.
• 11:40
  Dr. Komal Patil-Sisodia: The other thing that can impair sleep are hot flashes that tend to happen at night but can also happen any time during the day.
• 11:46
  Dr. Komal Patil-Sisodia: And then the pelvic floor gets weaker because we're not able to hold on to muscle mass and all of the pelvic floor musculature starts weakening.
• 11:54
  Dr. Komal Patil-Sisodia: And that can lead to a whole host of other issues like urinary incontinence, urinary tract infections, vaginal dryness, pain with intercourse.
• 12:04
  Dr. Komal Patil-Sisodia: All of these things have a profound impact on our quality of life.
• 12:08
  Dr. Komal Patil-Sisodia: So it's really important for us to know that What it is we have to watch for because if we don't we're just going to keep having the same conversation, right?
• 12:17
  Dr. Komal Patil-Sisodia: I mean you see so many Jokes and memes on social media about aging, you know what over Christmas I remember watching all these videos of people sitting down to to wrap presents and then joking about how they can't get back up Forgot to mention one more our joints start Having issues in the form of osteoarthritis So all of these different things start building and what we see is quality of life declines, longevity starts declining.
• 12:45
  Dr. Komal Patil-Sisodia: But, you know, one of the things that I think is interesting to note is just even three, four generations ago, our ancestors were not living as long as we were, or we are.
• 12:55
  Dr. Komal Patil-Sisodia: We have science and technology and all this medical advancement that has extended our lifespans.
• 13:02
  Dr. Komal Patil-Sisodia: So previously when people were living maybe to 60, 65.
• 13:07
  Dr. Komal Patil-Sisodia: That was a shorter period from, you know, potentially your periods ending at 55 to have to go through all of these symptoms.
• 13:13
  Dr. Komal Patil-Sisodia: Now we're looking at another 30, 40, 50 years from when our periods stop.
• 13:19
  Dr. Komal Patil-Sisodia: And I really want women to be empowered to know what to look for so that you can start intervening early and have a better quality of life moving forward.
• 13:27
  Dr. Komal Patil-Sisodia: So, those are the, those are the things that I want you to know.
• 13:31
  Dr. Komal Patil-Sisodia: The other the other thing that I think is really important is that you have to know your family history.
• 13:37
  Dr. Komal Patil-Sisodia: Your family history and your genetics will dictate what your menopause looks like, and it looks different for everyone.
• 13:44
  Dr. Komal Patil-Sisodia: We are all so different in terms of our genetics and what one friend has may not be what another friend has may not be what another friend has.
• 13:53
  Dr. Komal Patil-Sisodia: There's even variation within families, so know your family history.
• 13:56
  Dr. Komal Patil-Sisodia: So the things that I tell my patients that they can do to empower themselves and that I want you to know about is, One.
• 14:03
  Dr. Komal Patil-Sisodia: One, know that perimenopause can start as early as your mid thirties.
• 14:07
  Dr. Komal Patil-Sisodia: Some women start feeling those changes really, really early on.
• 14:11
  Dr. Komal Patil-Sisodia: And unfortunately, because of not having great data in this area, we have been dismissive of women's concerns over, over that time period.
• 14:20
  Dr. Komal Patil-Sisodia: Number two, pay attention to any symptoms that you could be developing.
• 14:25
  Dr. Komal Patil-Sisodia: You live in your body every single day.
• 14:27
  Dr. Komal Patil-Sisodia: You know how things feel.
• 14:29
  Dr. Komal Patil-Sisodia: You know when things are shifting.
• 14:31
  Dr. Komal Patil-Sisodia: So pay attention to your bodies.
• 14:33
  Dr. Komal Patil-Sisodia: And number three, when you go and see your healthcare providers, speak up, ask questions, make sure that you're advocating for yourself, because we are at a time right now, like we talked about in the last episode that we are 20 years post the women's health initiative, hormone therapy trials.
• 14:49
  Dr. Komal Patil-Sisodia: We have not done a great job for advocating for women in when they're going through these changes.
• 14:55
  Dr. Komal Patil-Sisodia: That gets to, gets to change now with you becoming more empowered about your health and having these conversations with your health care providers.
• 15:03
  Dr. Komal Patil-Sisodia: So that wraps up our episode today.
• 15:06
  Dr. Komal Patil-Sisodia: I went through a lot of information.
• 15:09
  Dr. Komal Patil-Sisodia: And I would like you to feel free to go over to my website to the contact page.
• 15:14
  Dr. Komal Patil-Sisodia: The website is resetrecharge.
• 15:17
  Dr. Komal Patil-Sisodia: com and put in a question that you may have had that came up from this episode.
• 15:23
  Dr. Komal Patil-Sisodia: What I'd like to do is make sure that any future episodes we can either have an entire spinoff episode or answer these questions that are coming up.
• 15:32
  Dr. Komal Patil-Sisodia: So that I can give you more information because information is power ladies.
• 15:35
  Dr. Komal Patil-Sisodia: And this is the time to take our power back and make sure that we are keeping autonomy over our own bodies.
• 15:43
  Dr. Komal Patil-Sisodia: So thank you for joining me today.
• 15:45
  Dr. Komal Patil-Sisodia: Our next episode will be about breaking down the women's health initiative hormone therapy trials.
• 15:51
  Dr. Komal Patil-Sisodia: I hope you will join me for that.
• 15:52
  Dr. Komal Patil-Sisodia: And I'm really excited to see you there.
• 15:54
  Dr. Komal Patil-Sisodia: Thank you.
• 15:55
  Dr. Komal Patil-Sisodia: Bye.