Latest / Clearly Hormonal / Ep 41: Pregnancy to Perimenopause with Dr. Emmie Strassberg

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Ep 41: Pregnancy to Perimenopause with Dr. Emmie Strassberg · 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: Hi everyone.
• 0:55
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:57
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:58
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia.
• 0:59
  Dr. Komal Patil-Sisodia: Today's episode is going to focus on women who are struggling during their pregnancies, have had difficulty in a past pregnancy or have had difficulty getting to a point where they can actually carry a pregnancy to term and in order to discuss that, especially since this seems to happen in women who are 40 plus when they're trying to conceive though it can happen to anybody.
• 1:23
  Dr. Komal Patil-Sisodia: I've invited Dr.
• 1:24
  Dr. Komal Patil-Sisodia: Emmie Strassberg, who is a maternal fetal medicine specialist.
• 1:28
  Dr. Komal Patil-Sisodia: She is also, seeing patients for preconception counseling and pregnancy planning, especially women who have had a difficult time getting or staying pregnant.
• 1:38
  Dr. Komal Patil-Sisodia: And we are going to talk about that also in the context of how women who are 40 plus and trying to get pregnant also can hit perimenopause.
• 1:48
  Dr. Komal Patil-Sisodia: As they're in postpartum and sometimes it's hard to tell the difference.
• 1:52
  Dr. Komal Patil-Sisodia: And there are health implications that happen during a pregnancy that can have, implications for long-term chronic health as well.
• 1:58
  Dr. Komal Patil-Sisodia: So I'm hoping to delve into all of that.
• 2:00
  Dr. Komal Patil-Sisodia: But welcome Dr.
• 2:01
  Dr. Komal Patil-Sisodia: Strasberg.
• 2:02
  Dr. Komal Patil-Sisodia: Thank you so much for joining us.
• 2:03
  Dr. Komal Patil-Sisodia: We're excited to have you.
• 2:05
  Dr. Komal Patil-Sisodia: Can you tell our listeners a little bit more about your background, where you trained, where you are now, where they can find you?
• 2:13
  Dr. Emmie Strassberg: Yeah.
• 2:13
  Dr. Emmie Strassberg: Thank you so much for having me.
• 2:14
  Dr. Emmie Strassberg: My name is Emmie Strassberg.
• 2:15
  Dr. Emmie Strassberg: I went to med school at Nova Southeastern in Fort Lauderdale, so I'm an osteopathic physician.
• 2:20
  Dr. Emmie Strassberg: I went to residency in Long Island at Good Samaritan Hospital in West Islip, and I did my fellowship at Geisinger in Central Pennsylvania.
• 2:28
  Dr. Emmie Strassberg: And then after that I worked for the last eight years in the Shenandoah Valley in Virginia, at a hospital MFM practice and, which was wonderful..
• 2:38
  Dr. Emmie Strassberg: But since the summer I have left and I'm now, working in a preconception counseling, telemedicine clinic that I've created.
• 2:46
  Dr. Emmie Strassberg: And starting that this month, and then I'm doing some other telemedicine on the side as well.
• 2:51
  Dr. Komal Patil-Sisodia: That is wonderful, and your background speaks to itself.
• 2:55
  Dr. Komal Patil-Sisodia: I was really excited to see that we had a mutual friend in common, Dr.
• 2:59
  Dr. Komal Patil-Sisodia: Dani Henderson, who Oh yeah.
• 3:01
  Dr. Komal Patil-Sisodia: Who I work with.
• 3:02
  Dr. Komal Patil-Sisodia: And you all know each other, through your societies.
• 3:05
  Dr. Komal Patil-Sisodia: Yeah.
• 3:05
  Dr. Emmie Strassberg: And she's also we're involved with the American College of Osteopathic Obstetricians and Gynecologists, which is a great organization.
• 3:11
  Dr. Emmie Strassberg: So I know her through there.
• 3:13
  Dr. Komal Patil-Sisodia: Oh, that's wonderful.
• 3:14
  Dr. Komal Patil-Sisodia: We run in some of the similar circles working with Dr.
• 3:17
  Dr. Komal Patil-Sisodia: Rentea and, have a few other people in common.
• 3:19
  Dr. Komal Patil-Sisodia: So it's been really fun to get to know you.
• 3:21
  Dr. Komal Patil-Sisodia: Let's talk, about your core coaching work.
• 3:25
  Dr. Komal Patil-Sisodia: There are so many women, myself included, and I've shared this story.
• 3:28
  Dr. Komal Patil-Sisodia: Four who have had multiple pregnancy losses for the listeners out there.
• 3:33
  Dr. Komal Patil-Sisodia: I was able to get pregnant pretty easily with my son, and after that I was not able to stay pregnant.
• 3:39
  Dr. Komal Patil-Sisodia: So this particular topic is near and dear to my heart because as somebody who went through multiple miscarriages trying to have a second child and then eventually gave up, I wish that I had found a doctor like Dr.
• 3:50
  Dr. Komal Patil-Sisodia: Strasberg.
• 3:51
  Dr. Komal Patil-Sisodia: Somebody who's educated, somebody who is compassionate, somebody who can give you hope in this next stage of life.
• 3:58
  Dr. Komal Patil-Sisodia: Because too often women go through this alone.
• 4:00
  Dr. Komal Patil-Sisodia: And I will say it's probably one of the most isolating times in my life.
• 4:05
  Dr. Komal Patil-Sisodia: You just don't know what you don't know.
• 4:07
  Dr. Komal Patil-Sisodia: And even me as a physician, I didn't know where to turn and or who to go to.
• 4:12
  Dr. Komal Patil-Sisodia: So I would.
• 4:13
  Dr. Komal Patil-Sisodia: Love to hear from you the difference between the traditional medical model that we see, women, because I did see an MFM,.
• 4:20
  Dr. Komal Patil-Sisodia: But I think what you're doing is like MFM plus or MFM 2.0 is what I'd like to call.
• 4:28
  Dr. Komal Patil-Sisodia: How do you look at the difference between those two?
• 4:32
  Dr. Emmie Strassberg: Yeah, so actually back in 2020, I went and got a life coach certification through the life coach school because I really wanted to be able to provide more to my patients than just a short office visit.
• 4:44
  Dr. Emmie Strassberg: Yeah.
• 4:44
  Dr. Emmie Strassberg: Because I have found that so many women are just going through so much in pregnancy and pregnancy makes it harder and our medical system doesn't make it easier.
• 4:53
  Dr. Emmie Strassberg: And so I did do some pregnancy coaching for a while separate from being a physician.
• 4:58
  Dr. Emmie Strassberg: And now when I'm doing this preconception counseling work, I'm just sort of incorporating that into the medical practice.
• 5:05
  Dr. Emmie Strassberg: Yeah.
• 5:05
  Dr. Emmie Strassberg: Where we can go more in depth and really look at everything that's going on in a person's life and really figure out what they need to have a healthy conception, a healthy pregnancy.
• 5:15
  Dr. Emmie Strassberg: Yeah.
• 5:16
  Dr. Emmie Strassberg: I'm so sorry that you went through that with the multiple miscarriages.
• 5:19
  Dr. Emmie Strassberg: So many women do, and it's just so sad to me that everybody feels so isolated because there are so many people out there with this Yes.
• 5:25
  Dr. Emmie Strassberg: With this issue.
• 5:26
  Dr. Emmie Strassberg: And they often do get overlooked.
• 5:28
  Dr. Emmie Strassberg: I just actually had somebody comment on my social media on a post that I made about recurrent pregnancy loss, that she'd had nine losses and felt like nobody had done anything about it.
• 5:38
  Dr. Emmie Strassberg: And that's just really sad because there's so much we can do for that.
• 5:41
  Dr. Emmie Strassberg: There's a lot of things that we can look into, and it just takes the time and the effort.
• 5:46
  Dr. Emmie Strassberg: And the problem with being in a hospital focused, maternal fetal medicine practice is that you're very busy and your priority has to be the high risk pregnant patients because they're on a strict timeline.
• 5:58
  Dr. Emmie Strassberg: Yeah.
• 5:58
  Dr. Emmie Strassberg: You can't push off any of their visits for months.
• 6:01
  Dr. Emmie Strassberg: But preconception counseling, so pre like pregnancy planning, that isn't as prioritized because they're not pregnant yet, which is silly, but.
• 6:10
  Dr. Emmie Strassberg: That's just the way it is.
• 6:11
  Dr. Emmie Strassberg: So I was the one in my practice that did these consults and I kind of had to fight for the time to do them.
• 6:16
  Dr. Emmie Strassberg: And then of course when you're talking about like reimbursement, they're not reimbursed as much as say, an ultrasound and No.
• 6:21
  Dr. Emmie Strassberg: So they just, they don't get prioritized the way they should.
• 6:24
  Dr. Komal Patil-Sisodia: Yeah.
• 6:25
  Dr. Komal Patil-Sisodia: And i'm just grateful to hear that there are people like you out there who can do that I made my peace with my process and I have some thoughts about it that I've gone back and looked over my medical records and whatnot and I think there were probably some things that could have been done, but hindsight is 2020 and here we are today.
• 6:42
  Dr. Komal Patil-Sisodia: Can you tell our listeners a little bit about how what you do is different than reproductive endocrinology or the.
• 6:49
  Dr. Komal Patil-Sisodia: Process of getting pregnant through IVF and IUI.
• 6:52
  Dr. Komal Patil-Sisodia: Because I know in our conversations, like in my mind, it all runs together.
• 6:55
  Dr. Komal Patil-Sisodia: And if that's happening to me, that's gonna happen to our listeners and I want them to know the difference because you're not a reproductive endocrinologist, right?
• 7:04
  Dr. Emmie Strassberg: So this is like the one area that maternal fetal medicine, high risk pregnancy specialists and reproductive endocrinologists, or IVF fertility specialists come together a lot in that.
• 7:15
  Dr. Emmie Strassberg: A lot of the times when women are going through fertility workup, their doctor who's doing the fertility workup, who is not me.
• 7:22
  Dr. Emmie Strassberg: Finds things like recurrent pregnancy loss or chronic health problems or other concerns that they want the woman to speak to a higher risk pregnancy specialist about, before they get pregnant.
• 7:34
  Dr. Emmie Strassberg: I see.
• 7:35
  Dr. Emmie Strassberg: So what I do is more pregnancy planning.
• 7:38
  Dr. Emmie Strassberg: Planning for a healthy conception.
• 7:40
  Dr. Emmie Strassberg: Not the conception itself.
• 7:42
  Dr. Emmie Strassberg: Yeah.
• 7:42
  Dr. Emmie Strassberg: And there are some things that I can talk to patients about, lifestyle changes, that can of course help move towards better fertility.
• 7:52
  Dr. Emmie Strassberg: Yeah., But the actual fertility workup, management and treatment is done by a fertility specialist, also called a reproductive endocrinologist.
• 7:59
  Dr. Emmie Strassberg: Yeah.
• 7:59
  Dr. Emmie Strassberg: Also called
• 8:01
  Dr. Komal Patil-Sisodia: IVF, you know, specialists.
• 8:03
  Dr. Komal Patil-Sisodia: Yeah, and it's interesting because as an endocrinologist, I have a lot of people call my office and say, well, do you do IVF and reproductive endocrinology?
• 8:10
  Dr. Komal Patil-Sisodia: And I'm like, no.
• 8:10
  Dr. Komal Patil-Sisodia: Different kind of endocrinologist.
• 8:12
  Dr. Komal Patil-Sisodia: Yeah, exactly.
• 8:13
  Dr. Komal Patil-Sisodia: Different kind of endocrinologist.
• 8:14
  Dr. Komal Patil-Sisodia: So the terminology is very confusing and so it's always nice to have a reset there.
• 8:19
  Dr. Komal Patil-Sisodia: So I imagine you.
• 8:21
  Dr. Komal Patil-Sisodia: From my own experience and probably from what I've seen in my office, because I do see a lot of these patients, one of my areas of interest has been thyroid disorders in pregnancy.
• 8:30
  Dr. Komal Patil-Sisodia: I think we talked about that a little bit.
• 8:32
  Dr. Komal Patil-Sisodia: I see a lot of these patients come into my office as well, and it is such a complex time,, in their lives in terms of all of the emotions that are going through.
• 8:41
  Dr. Komal Patil-Sisodia: And people feel, I know I felt very broken during that time.
• 8:45
  Dr. Komal Patil-Sisodia: Like my body just wasn't doing what it was supposed to do.
• 8:47
  Dr. Komal Patil-Sisodia: That.
• 8:48
  Dr. Komal Patil-Sisodia: All women have done for, centuries and like I was telling myself tales in my head about like how I was the only one who was failing at this.
• 8:55
  Dr. Komal Patil-Sisodia: How do you help your patients, recognize that, validate what they're feeling, and work through that process, because that's a big piece of this if you're not in a good head space, how are you going to get to the next step of trying to actually conceive?
• 9:09
  Dr. Emmie Strassberg: Well, I think identifying the problem is really helpful.
• 9:12
  Dr. Emmie Strassberg: Because you think about a car, if your transmission is not working, it's not that, you have a car that's never gonna work, you just need to replace the transmission.
• 9:20
  Dr. Emmie Strassberg: I don't know much about cars, so, yeah, that might be a silly analogy,, but yeah, so, it's not a moral problem.
• 9:25
  Dr. Emmie Strassberg: And I think too much society tells the story of well women, we're meant to have children.
• 9:30
  Dr. Emmie Strassberg: If you can't do that, then there's something wrong with you.
• 9:31
  Dr. Emmie Strassberg: Yeah.
• 9:32
  Dr. Emmie Strassberg: Or if you can't do it the right way, then there's something wrong with you.
• 9:34
  Dr. Emmie Strassberg: And I think women internalize that a lot.
• 9:37
  Dr. Emmie Strassberg: And there's no right way to be a pregnant person., Everybody's body is different.
• 9:42
  Dr. Emmie Strassberg: Everybody's pregnancy is going to be different and everybody's health is going to be different.
• 9:46
  Dr. Emmie Strassberg: And that includes pregnancy.
• 9:48
  Dr. Emmie Strassberg: And really separating that from you as a person that has a body and a health condition can be helpful.
• 9:54
  Dr. Emmie Strassberg: And some of that really needs a therapist more than me, it's not that there's nothing wrong with your body it's more that, every body has a certain capacity for health that's, Osteopathic principle, and we want to move that, we wanna move towards that capacity.
• 10:09
  Dr. Komal Patil-Sisodia: That's really a lovely way of reframing it, that your body is doing a certain thing, but we can work around the things that they're doing.
• 10:16
  Dr. Komal Patil-Sisodia: So how do you use your coaching principles?
• 10:19
  Dr. Komal Patil-Sisodia: I know you alluded to some of this has to.
• 10:22
  Dr. Komal Patil-Sisodia: B dealt with in therapy, which I went down that road, so, yes.
• 10:26
  Dr. Komal Patil-Sisodia: Yeah, and it was really helpful actually.
• 10:28
  Dr. Komal Patil-Sisodia: But for you, how are you using your coaching principles to help draw that out and how do you make a determination for when coaching will be enough versus when you send somebody to therapy?
• 10:39
  Dr. Emmie Strassberg: First of all, you always have to get consent for coaching.
• 10:42
  Dr. Emmie Strassberg: You never wanna coach somebody who has not given you their consent to coach them.
• 10:45
  Dr. Emmie Strassberg: Because a lot of people are not in a place where they want to be coached.
• 10:48
  Dr. Emmie Strassberg: They are having a problem, they don't wanna think about it any other way, and that's what it is.
• 10:52
  Dr. Emmie Strassberg: But if they're open to thinking about something differently, sometimes you can bring in curiosity, which is one of my favorite coaching tools.
• 10:59
  Dr. Emmie Strassberg: That's so interesting that that's how you see this.
• 11:03
  Dr. Emmie Strassberg: Is it possible that we could also look at it this way?
• 11:06
  Dr. Emmie Strassberg: Instead.
• 11:07
  Dr. Emmie Strassberg: Or what else might be possible.
• 11:11
  Dr. Emmie Strassberg: So just reframing the perspective around the story they've told themselves about their pregnancy or their prior bad outcome or difficult outcome.
• 11:21
  Dr. Emmie Strassberg: Is.
• 11:21
  Dr. Emmie Strassberg: I think that's great.
• 11:22
  Dr. Emmie Strassberg: Sometimes the stories that they're telling themselves are like far from actual facts.
• 11:27
  Dr. Emmie Strassberg: So just being able to receive the factual medical information, no, this is actually what happened.
• 11:31
  Dr. Emmie Strassberg: There's nothing that you could have done to prevent this.
• 11:35
  Dr. Emmie Strassberg: And actually what your doctors were doing was the best they can to save you and your baby.
• 11:41
  Dr. Emmie Strassberg: But that maybe wasn't communicated the best in the moment.
• 11:44
  Dr. Emmie Strassberg: Yeah.
• 11:44
  Dr. Emmie Strassberg: Sometimes that can be really helpful just to get a fresh perspective.
• 11:49
  Dr. Komal Patil-Sisodia: And I love that you are focusing on that because so often when you go into like your standard OB visit or even a visit at.
• 11:59
  Dr. Komal Patil-Sisodia: A very busy MFM clinic.
• 12:01
  Dr. Komal Patil-Sisodia: You're booked in 15, 10, 15 minute spots go through, the workup and then move on to the next one.
• 12:07
  Dr. Komal Patil-Sisodia: From experience, I know that that's really hard you know, it's unfortunate that our healthcare system is.
• 12:14
  Dr. Komal Patil-Sisodia: Set up in a way that we don't have the time to give women who are going through this, that type of attention.
• 12:20
  Dr. Komal Patil-Sisodia: Could you share an example with me of how you've helped somebody kind of understand a past diagnosis that was very difficult.
• 12:30
  Dr. Komal Patil-Sisodia: Like, we see, intrauterine growth restriction, or, complications of preeclampsia or premature rupture of membranes, things like that, that, they're blaming themselves, they're blaming their body, they're blaming whatever it was they were doing in that pregnancy.
• 12:45
  Dr. Komal Patil-Sisodia: Can you share an example of like how you've helped somebody come through that and feel empowered before their next pregnancy?
• 12:53
  Dr. Emmie Strassberg: Honestly, one of my best examples is from one of my coaching clients.
• 12:57
  Dr. Emmie Strassberg: I don't wanna give too much detail'cause No, I have permission to share the story, but she had a very traumatic delivery experience that ended with a healthy mom and healthy baby.
• 13:05
  Dr. Emmie Strassberg: But Oh, that's, so the experience itself was really disturbing to her.
• 13:09
  Dr. Emmie Strassberg: And so we just debriefed everything that happened.
• 13:12
  Dr. Emmie Strassberg: And what happened is they had to move quickly to get her baby delivered.
• 13:17
  Dr. Emmie Strassberg: Mm-hmm.
• 13:17
  Dr. Emmie Strassberg: So they didn't really end up communicating super well with her.
• 13:20
  Dr. Emmie Strassberg: And so she had no idea why things happened the way they happened.
• 13:25
  Dr. Emmie Strassberg: And so just to be able to talk like, well, this is probably why this happened and that happened, and it doesn't really sound like anything went wrong except for that nobody really.
• 13:34
  Dr. Emmie Strassberg: Made sure that you understood what was
• 13:35
  Dr. Komal Patil-Sisodia: happening.
• 13:36
  Dr. Komal Patil-Sisodia: Yeah.
• 13:37
  Dr. Komal Patil-Sisodia: Oh gosh, that's so hard.
• 13:39
  Dr. Komal Patil-Sisodia: And that's the crux of it, right?
• 13:40
  Dr. Komal Patil-Sisodia: People just want communication.
• 13:42
  Dr. Komal Patil-Sisodia: They want to be heard,, they want to feel like their experience is validated.
• 13:46
  Dr. Komal Patil-Sisodia: And that.
• 13:47
  Dr. Komal Patil-Sisodia: It's not, them that's broken.
• 13:49
  Dr. Komal Patil-Sisodia: So I love that you were able to break that down for her and get her to see that, in an emergency, we're not gonna have time to sit and chat like this.
• 13:57
  Dr. Komal Patil-Sisodia: Right?
• 13:58
  Dr. Komal Patil-Sisodia: It's gonna happen.
• 13:59
  Dr. Komal Patil-Sisodia: Go, go, go, go, go.
• 14:00
  Dr. Komal Patil-Sisodia: But they did everything to the best of their ability and.
• 14:04
  Dr. Komal Patil-Sisodia: It sounds like it was a great outcome for all.
• 14:06
  Dr. Komal Patil-Sisodia: So that's really good.
• 14:07
  Dr. Komal Patil-Sisodia: That is really good.
• 14:08
  Dr. Komal Patil-Sisodia: What is one kind of practical mindset based tool that you recommend to women who are coming off of a very difficult pregnancy, or a prior loss?
• 14:21
  Dr. Komal Patil-Sisodia: What's a good tool that you give them to stay regulated during their next pregnancy?
• 14:25
  Dr. Komal Patil-Sisodia: Because that's hard.
• 14:26
  Dr. Komal Patil-Sisodia: Oh yeah.
• 14:27
  Dr. Komal Patil-Sisodia: That's really tough.
• 14:30
  Dr. Emmie Strassberg: I think for losses, one of the things that's really shown to help in future pregnancies, especially if it was a baby that they named, is to just focus on remembering that baby.
• 14:40
  Dr. Emmie Strassberg: Yeah.
• 14:41
  Dr. Emmie Strassberg: Because that baby will come up.
• 14:43
  Dr. Emmie Strassberg: I mean, you're gonna be in the same ultrasound room, you're gonna hit the same gestational age or the calendar date or something, and it's going to come up.
• 14:51
  Dr. Emmie Strassberg: And remembering and celebrating sometimes can help a little bit.
• 14:55
  Dr. Emmie Strassberg: Therapy is really helpful.
• 14:56
  Dr. Emmie Strassberg: And that's not like a tool or anything, but really if you're struggling with, it's almost like PTSD in that point.
• 15:01
  Dr. Emmie Strassberg: So yeah.
• 15:02
  Dr. Emmie Strassberg: Therapy can be helpful.
• 15:04
  Dr. Emmie Strassberg: But just grounding exercises, square breathing.
• 15:07
  Dr. Emmie Strassberg: Meditation, all of that stuff can be helpful as adjuncts.
• 15:10
  Dr. Emmie Strassberg: And then journaling is a really great tool.
• 15:12
  Dr. Emmie Strassberg: It's not for everyone.
• 15:13
  Dr. Emmie Strassberg: Not everybody likes to journal, but being able to get your thoughts on paper if that's something that works
• 15:18
  Dr. Komal Patil-Sisodia: for you, could be really helpful.
• 15:19
  Dr. Komal Patil-Sisodia: That's great.
• 15:20
  Dr. Komal Patil-Sisodia: So there's lots of tools that people can have.
• 15:23
  Dr. Komal Patil-Sisodia: Are, do you know, or do you have in your area any support groups for women who've gone through multiple losses or bad outcomes or anything like that?
• 15:33
  Dr. Komal Patil-Sisodia: I feel like that would be so helpful if I knew, yeah,
• 15:36
  Dr. Emmie Strassberg: I know they exist.
• 15:37
  Dr. Emmie Strassberg: The problem is and especially with some of the online groups, is that it can be really frightening or.
• 15:43
  Dr. Emmie Strassberg: Yeah.
• 15:43
  Dr. Emmie Strassberg: Like triggering for some overwhelming people when they start, people start posting about bad things that are happening to them.
• 15:50
  Dr. Emmie Strassberg: Yeah.
• 15:50
  Dr. Emmie Strassberg: Or that happened to them.
• 15:51
  Dr. Emmie Strassberg: And then the next person's reading is like, oh, well, is this gonna happen to me?
• 15:55
  Dr. Emmie Strassberg: So sometimes they can be helpful, but it just, it really depends.
• 15:58
  Dr. Emmie Strassberg: Yeah.
• 15:58
  Dr. Emmie Strassberg: I don't know of any in-person groups where I am.
• 16:01
  Dr. Emmie Strassberg: There's some good organizations that, do a lot of support.
• 16:04
  Dr. Emmie Strassberg: Like the Preeclampsia Foundation is great.
• 16:07
  Dr. Emmie Strassberg: Mm-hmm.
• 16:08
  Dr. Emmie Strassberg: And, recurrent Pregnancy Loss Association is another great organization that does a lot of patient advocacy work.
• 16:15
  Dr. Emmie Strassberg: And I know they have some support resources.
• 16:18
  Dr. Komal Patil-Sisodia: Well, that's great.
• 16:19
  Dr. Komal Patil-Sisodia: What I'll do is I'll make sure I post those, in the show notes below so that people have that, and there's so many different types of pregnancy complications that you can have.
• 16:29
  Dr. Komal Patil-Sisodia: As an endocrinologist I deal with.
• 16:30
  Dr. Komal Patil-Sisodia: Preexisting diabetes or gestational diabetes or even thyroid dysfunction.
• 16:36
  Dr. Komal Patil-Sisodia: But you see a different side of things with the preeclampsia, with additional complications on top of that.
• 16:42
  Dr. Komal Patil-Sisodia: Can we talk a little bit about that and how those.
• 16:45
  Dr. Komal Patil-Sisodia: Conditions connect to future cardiovascular or metabolic health, because I think that's important for people to know, right?
• 16:54
  Dr. Komal Patil-Sisodia: Because sometimes you have a bad outcome in a pregnancy, or, you have a complication in a prior pregnancy that then affects your health and may affect your fertility in a way.
• 17:03
  Dr. Komal Patil-Sisodia: And I don't know that we always talk about that or what the long-term risk for women will be when they've had gestational diabetes or high blood pressure during pregnancy or something like that.
• 17:13
  Dr. Emmie Strassberg: Yeah.
• 17:13
  Dr. Emmie Strassberg: I mean those are the two big ones for chronic health.
• 17:15
  Dr. Emmie Strassberg: So gestational diabetes, you have like a 50 to 70% chance of developing diabetes later in life if you have gestational diabetes in pregnancy.
• 17:23
  Dr. Komal Patil-Sisodia: Yeah.
• 17:23
  Dr. Komal Patil-Sisodia: And of
• 17:23
  Dr. Emmie Strassberg: course there's not nothing that you can do about that.
• 17:26
  Dr. Komal Patil-Sisodia: Yeah.
• 17:26
  Dr. Emmie Strassberg: And same with, preeclampsia will increase your risk for cardiovascular health.
• 17:30
  Dr. Emmie Strassberg: I'm having trouble remember the number off the top of my head, but I think it's like 60%.
• 17:35
  Dr. Emmie Strassberg: Wow., Yeah.
• 17:35
  Dr. Emmie Strassberg: Cardiovascular.
• 17:36
  Dr. Emmie Strassberg: But, you know, cardiovascular disease is the number one killer of women anyway.
• 17:39
  Dr. Emmie Strassberg: So that's already higher risk for women.
• 17:41
  Dr. Emmie Strassberg: But if you have preeclampsia, you're at a higher risk.
• 17:44
  Dr. Komal Patil-Sisodia: Okay.
• 17:44
  Dr. Komal Patil-Sisodia: And that's good to know.
• 17:45
  Dr. Komal Patil-Sisodia: So, you know, with having that just one time though, right?
• 17:50
  Dr. Komal Patil-Sisodia: Like in one pregnancy, that's the percentage risk of increase.
• 17:54
  Dr. Emmie Strassberg: The more severe it is, the higher the risk leader in life.
• 17:57
  Dr. Emmie Strassberg: To the point that when I was at, in my fellowship, it was protocol that if patients had what we call like severe preeclampsia Yeah.
• 18:04
  Dr. Emmie Strassberg: They would be seen by a cardiologist.
• 18:07
  Dr. Emmie Strassberg: We had like a, agreement with cardiology that they would then get these patients in and just do like a baseline cardiovascular evaluation and then, make sure that they weren't.
• 18:16
  Dr. Emmie Strassberg: Completely lost a follow up.
• 18:17
  Dr. Emmie Strassberg: Yeah.
• 18:17
  Dr. Komal Patil-Sisodia: Yeah, that's, I mean, I think that's great.
• 18:20
  Dr. Komal Patil-Sisodia: I know we talked about, in my fellowship, we worked very closely with the MFM team as well, and we ran a joint endocrine slash MFM clinic for the thyroid dysfunction and pregnancy.
• 18:31
  Dr. Komal Patil-Sisodia: Mm-hmm.
• 18:31
  Dr. Komal Patil-Sisodia: And also gestational diabetes in pregnancy.
• 18:33
  Dr. Komal Patil-Sisodia: And you know, one of the things that I see in my practice is that women who've had gestational diabetes during pregnancy.
• 18:39
  Dr. Komal Patil-Sisodia: A lot of them, they get so busy postpartum, they don't come back for their three month mm-hmm.
• 18:44
  Dr. Komal Patil-Sisodia: Postpartum glucose tolerance test to figure out whether the diabetes has resolved or not.
• 18:48
  Dr. Komal Patil-Sisodia: And so sometimes it just goes unchecked for years.
• 18:52
  Dr. Komal Patil-Sisodia: I know for me my primary care doctor still makes fun of me because I went to establish my first visit with her and she was like, when was the last time you saw a doctor?
• 19:00
  Dr. Komal Patil-Sisodia: And I gave her a date.
• 19:01
  Dr. Komal Patil-Sisodia: And she's like, so your postpartum visit with your gynecologist, it was like five years later at this.
• 19:06
  Dr. Komal Patil-Sisodia: Point.
• 19:06
  Dr. Komal Patil-Sisodia: Yeah.
• 19:07
  Dr. Komal Patil-Sisodia: I guess I'm lucky that nothing bad happened in the meantime, but it is hard to find that time to come in and actually take care of yourself.
• 19:17
  Dr. Komal Patil-Sisodia: So a hundred
• 19:17
  Dr. Emmie Strassberg: percent And mothers are doing so much, they're taking care of their families.
• 19:20
  Dr. Emmie Strassberg: They're working.
• 19:21
  Dr. Komal Patil-Sisodia: Yes.
• 19:22
  Dr. Komal Patil-Sisodia: Life happens,
• 19:23
  Dr. Emmie Strassberg: you know,
• 19:24
  Dr. Komal Patil-Sisodia: It really does., Let's talk a little bit about common reproductive health challenges that kind of occur between.
• 19:35
  Dr. Komal Patil-Sisodia: Pregnancy and perimenopause, like PCOS development of fibroids, things like that.
• 19:40
  Dr. Komal Patil-Sisodia: What is the biggest misconception women have about managing their chronic reproductive conditions in their thirties and forties?
• 19:49
  Dr. Komal Patil-Sisodia: And we can toss endometriosis and adenomyosis in there because again, this is something that I went through and totally ignored because I thought that there was nothing to be done at this point.
• 20:01
  Dr. Komal Patil-Sisodia: That's not the case.
• 20:02
  Dr. Komal Patil-Sisodia: Women have options.
• 20:03
  Dr. Komal Patil-Sisodia: They can get treatment and things like that.
• 20:04
  Dr. Komal Patil-Sisodia: From your perspective, how do you start talking to your patients about that?
• 20:09
  Dr. Emmie Strassberg: Yeah, I think, what's really, encouraging is a lot of women are getting on top of that,, more than their doctors, honestly, sometimes.
• 20:16
  Dr. Komal Patil-Sisodia: Yes.
• 20:17
  Dr. Emmie Strassberg: They are educating themselves about their, endometriosis and PCOS and all of that and, I've had several patients that have had, those concerns brushed off in the past and, then they get pregnant.
• 20:27
  Dr. Emmie Strassberg: And, endometriosis sometimes can have complications in pregnancy.
• 20:32
  Dr. Emmie Strassberg: Sometimes it gets better with pregnancy.
• 20:34
  Dr. Emmie Strassberg: Oh, really?
• 20:35
  Dr. Emmie Strassberg: Yeah.
• 20:35
  Dr. Emmie Strassberg: Some people have, improvement of symptoms with pregnancy and postpartum treatment.
• 20:40
  Dr. Emmie Strassberg: Okay.
• 20:40
  Dr. Emmie Strassberg: But others don't.
• 20:42
  Dr. Emmie Strassberg: Yeah.
• 20:42
  Dr. Emmie Strassberg: And, as far as PCOS, I think you just need to find a doctor that knows how to manage that correctly, because it is so confusing with, when is my cycle gonna happen and when am I ovulating or not ovulating?
• 20:55
  Dr. Emmie Strassberg: Yeah.
• 20:56
  Dr. Emmie Strassberg: Do I just go on birth control pills?
• 20:58
  Dr. Emmie Strassberg: And it depends on if you wanna get pregnant or not.
• 21:00
  Dr. Emmie Strassberg: The treatment's obviously very different.
• 21:02
  Dr. Emmie Strassberg: Yes.
• 21:03
  Dr. Emmie Strassberg: And then is there insulin resistance?
• 21:05
  Dr. Emmie Strassberg: And if there is and you want to get pregnant, how can we work on that before pregnancies?
• 21:09
  Dr. Emmie Strassberg: Yeah.
• 21:09
  Dr. Komal Patil-Sisodia: Yeah.
• 21:10
  Dr. Komal Patil-Sisodia: I see a lot of my PCOS patients go on to unfortunately develop some degree of gestational diabetes during pregnancy.
• 21:18
  Dr. Komal Patil-Sisodia: If they had insulin resistance subtype.
• 21:20
  Dr. Komal Patil-Sisodia: And I think that's the hard thing about PCOS to your point,
• 21:23
  Dr. Emmie Strassberg: What I find is even, sometimes their gestational diabetes tests, the one hour, which is like the initial challenge test will be elevated and even like mildly elevated, like one 30 to, I don't know, yeah, one 40.
• 21:34
  Dr. Emmie Strassberg: And then sometimes they'll do the three hour test and that will be normal.
• 21:37
  Dr. Emmie Strassberg: Or they'll one elevation, but otherwise, technically they don't rule in for gestational diabetes, but they still end up having sometimes some of the complications that we see where baby's measuring really big
• 21:48
  Dr. Komal Patil-Sisodia: or
• 21:49
  Dr. Emmie Strassberg: there's extra amniotic fluid.
• 21:52
  Dr. Emmie Strassberg: And sometimes we still see some of those.
• 21:53
  Dr. Emmie Strassberg: Gestational diabetes type, not as strongly as if they had gestational diabetes.
• 21:57
  Dr. Emmie Strassberg: We still see some things like that.
• 22:00
  Dr. Komal Patil-Sisodia: That's interesting because I remember when I was pregnant with my son, that was the year that the cutoff for that one hour test went from one 40 to one 30, and I think I was right at that one 30 and they were like, you have to do the three hour test.
• 22:14
  Dr. Komal Patil-Sisodia: And I was one of those people That was totally fine.
• 22:17
  Dr. Komal Patil-Sisodia: But now, I think back and I'm like, who knows?.
• 22:20
  Dr. Komal Patil-Sisodia: Well, it's interesting, so,
• 22:21
  Dr. Emmie Strassberg: The cutoff of one 40, a lot of people still use that and it really should depend on what your population is.
• 22:26
  Dr. Emmie Strassberg: And honestly in this day and age that's fair.
• 22:29
  Dr. Emmie Strassberg: One 30 is probably decent cutoff and I've known people using 1 35.
• 22:32
  Dr. Emmie Strassberg: So it just depends.
• 22:33
  Dr. Emmie Strassberg: Yeah.
• 22:33
  Dr. Emmie Strassberg: But if I have a patient that has PCOS or they, have obesity or they have
• 22:39
  Dr. Komal Patil-Sisodia: yeah,
• 22:39
  Dr. Emmie Strassberg: any risk factor for insulin resistance and they have a one 30, then I will have them do the three hour test.
• 22:47
  Dr. Emmie Strassberg: Much to their chagrin and honestly I feel like we could come up with better testing.
• 22:51
  Dr. Komal Patil-Sisodia: Oh my gosh, whatever that concoction is.
• 22:54
  Dr. Komal Patil-Sisodia: I remember sitting there in the one hour test and I was in the lab and it wasn't just like an OB lab, it was.
• 23:01
  Dr. Komal Patil-Sisodia: A lab with a bunch of other people, and I drank that, what is it, like 50 or 75 grams of glucose?
• 23:06
  Dr. Komal Patil-Sisodia: The three
• 23:07
  Dr. Emmie Strassberg: hours, a hundred grams of glucose?
• 23:08
  Dr. Emmie Strassberg: No, no,
• 23:09
  Dr. Komal Patil-Sisodia: this was the first one.
• 23:10
  Dr. Komal Patil-Sisodia: Oh, that
• 23:10
  Dr. Emmie Strassberg: one's 50.
• 23:10
  Dr. Emmie Strassberg: Yeah,
• 23:11
  Dr. Komal Patil-Sisodia: 50.
• 23:11
  Dr. Komal Patil-Sisodia: Right.
• 23:12
  Dr. Komal Patil-Sisodia: And all of a sudden you just see my belly rippling like this.
• 23:16
  Dr. Komal Patil-Sisodia: It was like my child was trying to bust out and the man sitting next to me, he was like staring at my stomach and he's like.
• 23:24
  Dr. Komal Patil-Sisodia: Are you okay?
• 23:25
  Dr. Komal Patil-Sisodia: I think he thought like a gremlin was gonna shoot out of my belly like alien.
• 23:28
  Dr. Komal Patil-Sisodia: Exactly.
• 23:30
  Dr. Komal Patil-Sisodia: Because I was like, wow, he is like getting hopped up off of sugar.
• 23:33
  Dr. Komal Patil-Sisodia: He is like, you see like all this movement along the way, but yeah, we need to come up with better testing for women.
• 23:40
  Dr. Komal Patil-Sisodia: 'cause that was not a pleasant experience for either of those tests.
• 23:44
  Dr. Komal Patil-Sisodia: Possibly worse for the second one because there's less room by that point and more sugar.
• 23:49
  Dr. Komal Patil-Sisodia: So,
• 23:50
  Dr. Emmie Strassberg: well, I've had patients that can't even tolerate, they'll do a three hour test and then they throw up in the middle.
• 23:54
  Dr. Emmie Strassberg: So you can't really make it, it's not accurate.
• 23:56
  Dr. Emmie Strassberg: And so then sometimes we do alternative testing, which is.
• 24:00
  Dr. Emmie Strassberg: Not great because it's not as well studied.
• 24:02
  Dr. Emmie Strassberg: Yeah.
• 24:03
  Dr. Emmie Strassberg: So basically have people check their blood sugars four times a day for one to two weeks and, see what's happening.
• 24:08
  Dr. Emmie Strassberg: Or now we're getting a little bit more into using CGMs.
• 24:11
  Dr. Emmie Strassberg: I was just gonna ask
• 24:12
  Dr. Komal Patil-Sisodia: that question.
• 24:13
  Dr. Komal Patil-Sisodia: Is there a particular one that you prefer in pregnancy?
• 24:16
  Dr. Emmie Strassberg: Not particularly.
• 24:18
  Dr. Emmie Strassberg: The two ones that I know about Dexcom and the Libres, I think the Dexcoms are more likely to be, at least where I was, they're more likely to be covered by insurance.
• 24:26
  Dr. Emmie Strassberg: But,
• 24:26
  Dr. Komal Patil-Sisodia: um, yeah, no, that,'cause we had a good Dexcom rep.
• 24:29
  Dr. Komal Patil-Sisodia: I think that's a great point.
• 24:33
  Dr. Komal Patil-Sisodia: Yeah.
• 24:33
  Dr. Komal Patil-Sisodia: I think that I have
• 24:34
  Dr. Emmie Strassberg: received no money from Dexcom.
• 24:35
  Dr. Emmie Strassberg: Yeah.
• 24:35
  Dr. Komal Patil-Sisodia: Neither have I.
• 24:37
  Dr. Komal Patil-Sisodia: Or Libre, but I use both equally.
• 24:39
  Dr. Komal Patil-Sisodia: They're both excellent products, so I just wasn't sure if there was an edge for one over the other in pregnancy, so,
• 24:45
  Dr. Emmie Strassberg: yeah.
• 24:45
  Dr. Emmie Strassberg: It's so interesting when people think about it too.
• 24:47
  Dr. Emmie Strassberg: Like I had a patient the other day that was like, do I really have to check my blood sugar four times a day?
• 24:52
  Dr. Emmie Strassberg: Like, you're telling me I have to do this, rest my pregnancy, I have to prick my finger.
• 24:54
  Dr. Emmie Strassberg: I said, well, we could see if you're,'cause she was a pre gestational, we could see if you're, insurance will cover a continuous glucose monitor, but she thought that was even creepier.
• 25:02
  Dr. Emmie Strassberg: She's like, it's just gonna sit in my skin for two weeks.
• 25:05
  Dr. Komal Patil-Sisodia: Yeah, I know it really comes down to the individual person's tolerance of what they're, yeah.
• 25:10
  Dr. Emmie Strassberg: It's less invasive than pricking your finger.
• 25:12
  Dr. Emmie Strassberg: Really.
• 25:13
  Dr. Komal Patil-Sisodia: I agree.
• 25:14
  Dr. Komal Patil-Sisodia: I get to play with all of those things.
• 25:15
  Dr. Komal Patil-Sisodia: Yeah.
• 25:15
  Dr. Komal Patil-Sisodia: 'cause the reps bring them to my office and I would much rather,.
• 25:20
  Dr. Komal Patil-Sisodia: Well, one, I'm needle phobic.
• 25:21
  Dr. Komal Patil-Sisodia: They call me doctor chicken at the lab because I'm very drunk when they draw my blood.
• 25:25
  Dr. Komal Patil-Sisodia: But I would wear the continuous glucose monitor if it were up to me.
• 25:28
  Dr. Komal Patil-Sisodia: 'cause I don't like poking my fingers so right know., But it's what it is different for each person, for sure.
• 25:35
  Dr. Komal Patil-Sisodia: And you know, you talked a little bit about how like women are doing so much more education in terms of knowing what's going on with their health, and I love to see it mm-hmm.
• 25:43
  Dr. Komal Patil-Sisodia: Because as physicians, you and I both know that women haven't been included in medical studies for the better part of.
• 25:51
  Dr. Komal Patil-Sisodia: All of history.
• 25:53
  Dr. Komal Patil-Sisodia: Yeah, exactly.
• 25:54
  Dr. Komal Patil-Sisodia: Just since 1993 did we actually make it into a study.
• 25:58
  Dr. Komal Patil-Sisodia: And then that got shut down, not even a decade later for a little bit with the Women's Health Initiative mm-hmm.
• 26:04
  Dr. Komal Patil-Sisodia: We kind of shied away from doing stuff with women again., But now,.
• 26:08
  Dr. Komal Patil-Sisodia: We are seeing women be more educated about pregnancy and what that means for them.
• 26:12
  Dr. Komal Patil-Sisodia: I'm also seeing it for the women who are hitting perimenopause because this is where I start to see endocrine disorders get significantly worse.
• 26:20
  Dr. Komal Patil-Sisodia: And one of the things is that for women who are having babies in their forties, what I'm finding in my practice, and I'd love to hear more from you on, is that transition from being immediately.
• 26:30
  Dr. Komal Patil-Sisodia: Postpartum to then hitting perimenopause and what that looks like sometimes, because not only is perimenopause starting to increase your risk for all of those metabolic health conditions, like higher blood sugars, higher blood pressure, higher cholesterol, but you're also having all these other symptoms, that can overlap with those of postpartum.
• 26:50
  Dr. Komal Patil-Sisodia: So how do you, or have you had to help your patients sort that out a little bit?
• 26:54
  Dr. Emmie Strassberg: Well, I don't normally see people that are postpartum because once they're, done being pregnant, they're ob gyn but I will see them pre-pregnancy if they're planning another pregnancy.
• 27:03
  Dr. Emmie Strassberg: Yeah.
• 27:03
  Dr. Emmie Strassberg: But it is difficult because, the pregnancy hormones and pregnancy brain's a real thing too.
• 27:08
  Dr. Emmie Strassberg: And then you get to perimenopause and that can be really difficult.
• 27:13
  Dr. Emmie Strassberg: And then you have a newborn.
• 27:14
  Dr. Emmie Strassberg: So how much time are you really taking to go see your own doctor for yours?
• 27:18
  Dr. Emmie Strassberg: Five years later, perimenopause that you probably just assume is postpartum.
• 27:22
  Dr. Komal Patil-Sisodia: Yeah.
• 27:23
  Dr. Emmie Strassberg: Stuff.
• 27:23
  Dr. Komal Patil-Sisodia: So, yeah.
• 27:24
  Dr. Komal Patil-Sisodia: And it's hard because the postpartum mood disorders as well, do you see a higher rate of that in women who have gone through a difficult pregnancy or a bad outcome?
• 27:36
  Dr. Komal Patil-Sisodia: Higher risk for postpartum anxiety or depression?
• 27:41
  Dr. Emmie Strassberg: Sometimes there is, yeah, sometimes there is.
• 27:44
  Dr. Emmie Strassberg: It's interesting.
• 27:44
  Dr. Emmie Strassberg: People are just all very different.
• 27:47
  Dr. Emmie Strassberg: I've also had plenty of patients that,, seem to be not unaffected by loss, but they take it very differently.
• 27:55
  Dr. Emmie Strassberg: And then they're not anxious in the next pregnancy.
• 27:57
  Dr. Emmie Strassberg: And I always really wonder how those people get to where they are amazingly People just cope very differently and I don't know if it has, necessarily anything to do with, that or not.
• 28:06
  Dr. Emmie Strassberg: But that said, if you've had past abnormal pregnancy outcomes or, complicated outcomes, it is going to be a little bit more likely that you're gonna have anxiety For sure.
• 28:17
  Dr. Emmie Strassberg: And even depression.
• 28:18
  Dr. Emmie Strassberg: In the next pregnancy and postpartum.
• 28:21
  Dr. Emmie Strassberg: Okay.,
• 28:21
  Dr. Komal Patil-Sisodia: Good to know.
• 28:23
  Dr. Emmie Strassberg: Yeah.
• 28:23
  Dr. Emmie Strassberg: And then in vitro, I've noticed too, sometimes obviously there's some higher anxiety with that because just the anxiety of getting pregnant has been so high and then you are pregnant, so you think that you're going to be, relaxed because now you're pregnant, but now you're not relaxed'cause you're pregnant and you want the pregnancy to have good outcome.
• 28:40
  Dr. Emmie Strassberg: And then you think you're gonna be fine once the baby is born, and then you're have a child and have to deal with all of that.
• 28:45
  Dr. Emmie Strassberg: So
• 28:46
  Dr. Komal Patil-Sisodia: It's a lot.
• 28:46
  Dr. Komal Patil-Sisodia: I've had a lot of my patients go through IVF and IUI and even just the process of the degree of the hormones they give during the egg retrievals and things like that, or the continuous progesterone that people have to be on.
• 29:00
  Dr. Komal Patil-Sisodia: All of the mood changes that I see with that is very interesting too.
• 29:04
  Dr. Komal Patil-Sisodia: And how much of it is that they wanna actually have to go through this process and that's what's stressing them out versus how much of it is the actual side effect to some of the hormones.
• 29:13
  Dr. Komal Patil-Sisodia: I don't think we know that particularly well, so.
• 29:16
  Dr. Emmie Strassberg: Well, one thing I will say is that women who have baseline depression and anxiety that's not treated
• 29:22
  Dr. Komal Patil-Sisodia: Yeah.
• 29:22
  Dr. Komal Patil-Sisodia: Have
• 29:23
  Dr. Emmie Strassberg: a much higher risk of adverse pregnancy outcomes if it's not treated
• 29:28
  Dr. Komal Patil-Sisodia: interesting.
• 29:29
  Dr. Emmie Strassberg: So, making sure that mental health is treated is also really important.
• 29:32
  Dr. Emmie Strassberg: And that sometimes, I feel like that's sometimes a newer approach yeah.
• 29:36
  Dr. Emmie Strassberg: I still have patients that come and they're on multiple psych meds and they said, well, my psychiatrist just said to stop all of them because I'm pregnant, and they'll see me when I'm done being pregnant.
• 29:45
  Dr. Emmie Strassberg: I'm like, Ooh, that's not great.
• 29:47
  Dr. Emmie Strassberg: No.
• 29:47
  Dr. Emmie Strassberg: Luckily there are also some really, really great psychiatrists that I can coordinate with and we figure it out and we make sure the patient's well taken care of.
• 29:53
  Dr. Emmie Strassberg: But to be mentally not well or super stressed, does influence pregnancy outcomes as well and neonatal outcomes.
• 30:01
  Dr. Emmie Strassberg: And even bonding between mom and babies.
• 30:03
  Dr. Emmie Strassberg: I went to a really fascinating conference in, I think it was 2019, at the Fetal Brain Institute in dc which is at the Children's National.
• 30:12
  Dr. Emmie Strassberg: Yeah.
• 30:13
  Dr. Emmie Strassberg: And, they did a full conference on maternal mental health and how it affects the fetal brain.
• 30:18
  Dr. Emmie Strassberg: And it really affects it quite significantly weirdly male fetuses are more affected than females.
• 30:25
  Dr. Emmie Strassberg: Huh.
• 30:26
  Dr. Emmie Strassberg: Yeah.
• 30:27
  Dr. Komal Patil-Sisodia: I wonder why that is.
• 30:28
  Dr. Komal Patil-Sisodia: That's so interesting to me.
• 30:29
  Dr. Komal Patil-Sisodia: I
• 30:29
  Dr. Emmie Strassberg: think it has to do with hormones,.
• 30:31
  Dr. Emmie Strassberg: But what they found is that, women who had like higher ACE scores, so adverse childhood event scores, had more complicated pregnancies and then more difficulty bonding, and more chance of a child that had difficulties Wow.
• 30:44
  Dr. Emmie Strassberg: As well., So those things also need to be addressed and also need to be,.
• 30:49
  Dr. Emmie Strassberg: Treated optimally preconception, if possible.
• 30:52
  Dr. Emmie Strassberg: Yeah.
• 30:52
  Dr. Emmie Strassberg: And then through pregnancy so that we can make sure mom and baby are healthy and having good bonding, and good postpartum experience.
• 30:59
  Dr. Komal Patil-Sisodia: Yeah that I think is fair.
• 31:01
  Dr. Komal Patil-Sisodia: I think.
• 31:02
  Dr. Komal Patil-Sisodia: People are so scared of everything that they're doing during their pregnancies like, is taking this Tylenol safe for me in pregnancy?
• 31:11
  Dr. Komal Patil-Sisodia: And unfortunately right now we're getting really bad advice around that, mm-hmm.
• 31:14
  Dr. Komal Patil-Sisodia: I remember when.
• 31:15
  Dr. Komal Patil-Sisodia: I was pregnant, I had heartburn, so I took, what was it called?
• 31:19
  Dr. Komal Patil-Sisodia: Zantac or something, and then it got recalled later, And I was like, oh no, I took this during my pregnancy.
• 31:24
  Dr. Komal Patil-Sisodia: Or there's so many different things that, we get very afraid of doing during that time.
• 31:30
  Dr. Komal Patil-Sisodia: I have a lot of patients who are afraid to be on their anti-anxiety or anti-depression meds.
• 31:35
  Dr. Komal Patil-Sisodia: Yeah.
• 31:35
  Dr. Komal Patil-Sisodia: Because they worry about that.
• 31:37
  Dr. Komal Patil-Sisodia: But there are, from what I'm hearing from you, there are safe ones for pregnancy, correct.
• 31:42
  Dr. Komal Patil-Sisodia: Yeah.
• 31:43
  Dr. Komal Patil-Sisodia: And the safe is really
• 31:43
  Dr. Emmie Strassberg: not the word I like to use., it's not a fair word for the situation, but, when you look at risks and benefits, the benefit of being well controlled on most honestly most psychiatric medications, there's very few.
• 31:54
  Dr. Emmie Strassberg: I think Depakote is like the one that they're like, please don't use this medication in pregnancy.
• 31:57
  Dr. Emmie Strassberg: Yeah.
• 31:58
  Dr. Emmie Strassberg: The benefit.
• 31:59
  Dr. Emmie Strassberg: Outweighs that risk most of the time because that benefit of good maternal mental health, good maternal and neonatal bonding is gonna outweigh that risk.
• 32:09
  Dr. Emmie Strassberg: And they've done studies looking at women who are untreated and they have similar rates of neonatal withdrawal type symptoms or interesting NICU admission.
• 32:18
  Dr. Emmie Strassberg: Then women on the medication.
• 32:19
  Dr. Emmie Strassberg: So is it really the medication or is it just the, disease process itself or We don't know, but we know that women who are optimized.
• 32:28
  Dr. Komal Patil-Sisodia: Yeah.
• 32:28
  Dr. Komal Patil-Sisodia: Outcomes.
• 32:29
  Dr. Komal Patil-Sisodia: Yeah.
• 32:29
  Dr. Komal Patil-Sisodia: Yeah.
• 32:30
  Dr. Komal Patil-Sisodia: So it sounds like from your coaching perspective, there's so many different things that we have to talk through, especially for women who have been through a recurrent pregnancy loss or previous bad outcomes, to make sure that they're getting a really nice, comprehensive picture of all the different things that they can do.
• 32:49
  Dr. Komal Patil-Sisodia: And I'm gonna quote you, and I hope I don't say it wrong, but to the capacity of your body, which is that, is that you said,
• 32:56
  Dr. Emmie Strassberg: I think that's basically what I said.
• 32:58
  Dr. Emmie Strassberg: Yeah,
• 32:58
  Dr. Komal Patil-Sisodia: yeah, yeah.
• 32:59
  Dr. Komal Patil-Sisodia: And I like that term, right?
• 33:01
  Dr. Komal Patil-Sisodia: Because your body is made the way that your body is made, your genetics are your genetics.
• 33:05
  Dr. Komal Patil-Sisodia: And you work with what you have.
• 33:07
  Dr. Komal Patil-Sisodia: It's not to your point, a moral failure that, you inherited this from like generations of people in your family.
• 33:14
  Dr. Komal Patil-Sisodia: That passed it down.
• 33:15
  Dr. Komal Patil-Sisodia: That's not something that was, the hand of cards you were dealt.
• 33:18
  Dr. Komal Patil-Sisodia: So I think taking the blame off of people is such a beautiful thing because, we are our own harshest critics, especially as women.
• 33:26
  Dr. Komal Patil-Sisodia: We are so nitpicky with all of the things that we're doing.
• 33:29
  Dr. Komal Patil-Sisodia: I am just deeply appreciative that we have somebody like you who is mystifying all of that for our patients.
• 33:37
  Dr. Komal Patil-Sisodia: I really love that, you're focusing on empowering them.
• 33:40
  Dr. Komal Patil-Sisodia: You're focusing on educating them.
• 33:42
  Dr. Komal Patil-Sisodia: You're focusing on making sure that they have tools that they can use, even postpartum.
• 33:48
  Dr. Komal Patil-Sisodia: I know we wanted to talk a little bit about perimenopause and how women later in life who are delivering later in life can sometimes go straight into perimenopause.
• 33:57
  Dr. Komal Patil-Sisodia: I think that part of that is also education yeah.
• 34:00
  Dr. Komal Patil-Sisodia: And being aware of all of the different things that are happening.
• 34:03
  Dr. Komal Patil-Sisodia: What are some key, messages that you want our listeners, especially women, who are currently going through this process?
• 34:12
  Dr. Komal Patil-Sisodia: What do you want them to know in terms of their reproductive health and what they should be looking out for?
• 34:18
  Dr. Komal Patil-Sisodia: And what is it?
• 34:20
  Dr. Emmie Strassberg: I think just that,, having a pregnancy planning visit, a preconception consult can be really helpful, especially if you have had complications in previous pregnancies or you have chronic medical problems, or you have family history of genetic illnesses.
• 34:34
  Dr. Emmie Strassberg: It can be really helpful to talk about these things before pregnancy one, so we know what to expect.
• 34:39
  Dr. Emmie Strassberg: And two, so that we can optimize the chances of a healthy pregnancy before conception.
• 34:45
  Dr. Emmie Strassberg: And so basic things like, prenatal vitamins, everybody should be on a prenatal vitamin.
• 34:49
  Dr. Emmie Strassberg: If you have the at all capacity to get pregnant, prenatal vitamin is gonna be helpful to you.
• 34:54
  Dr. Emmie Strassberg: And luckily in this country, most food is fortified with folic acid.
• 34:58
  Dr. Emmie Strassberg: So, God forbid you get pregnant and you weren't taking a prenatal vitamin, you're probably fine.
• 35:02
  Dr. Emmie Strassberg: But if you want that benefit, take it, one to three months before pregnancy and yeah.
• 35:07
  Dr. Emmie Strassberg: Make sure you're up to date on your vaccinations because we don't wanna get infectious diseases while pregnant and there are certain vaccines that we can't get while pregnant.
• 35:15
  Dr. Emmie Strassberg: Knowing your family history.
• 35:17
  Dr. Emmie Strassberg: So if you don't know it, maybe talking to your parents or your partner and their parents and siblings and probably don't need to go past beyond that.
• 35:25
  Dr. Emmie Strassberg: Yeah, any previous children with health problems.
• 35:26
  Dr. Emmie Strassberg: So all that stuff is just helpful to think about before pregnancy.
• 35:31
  Dr. Emmie Strassberg: And, maybe it's not for everyone.
• 35:33
  Dr. Emmie Strassberg: Maybe people just like to go in and not think about it.
• 35:36
  Dr. Emmie Strassberg: And there are plenty of young women that do that and older women, and that's fine.
• 35:39
  Dr. Emmie Strassberg: But if you want to have more information and optimize your health, then that's a great option.
• 35:47
  Dr. Komal Patil-Sisodia: Yeah, that's fantastic.
• 35:49
  Dr. Komal Patil-Sisodia: And like I said before, had I been able to find somebody like you, I definitely would have come to your practice.
• 35:55
  Dr. Komal Patil-Sisodia: So can you tell us where you are seeing patients and how patients can find you if they do feel like they want to schedule, a counseling session with you?
• 36:05
  Dr. Emmie Strassberg: Yeah, so right now I am starting out in Virginia and Alaska.
• 36:08
  Dr. Emmie Strassberg: I live in Virginia, so I know a lot of people here.
• 36:11
  Dr. Emmie Strassberg: And, i'm already licensed in the state, so that was an easy place to start.
• 36:14
  Dr. Emmie Strassberg: And then I'm gonna be doing some work in Alaska this year with a friend of mine.
• 36:17
  Dr. Emmie Strassberg: Cool.
• 36:18
  Dr. Emmie Strassberg: Shout out to Carina Mueller and, Aurora Fetal Medicine in Anchorage.
• 36:22
  Dr. Emmie Strassberg: I'm gonna be doing, some locums work for her and, I have an Alaska license for the other telemedicine practice as well, so I thought I would.
• 36:29
  Dr. Emmie Strassberg: Also incorporate both.
• 36:30
  Dr. Emmie Strassberg: Yeah.
• 36:31
  Dr. Emmie Strassberg: Since I'll be meeting with people in person there, I really like connecting with people in person too.
• 36:35
  Dr. Emmie Strassberg: I know it's weird'cause I'm doing telemedicine, but it's nice to have that network of like doctors you've actually know.
• 36:40
  Dr. Komal Patil-Sisodia: Yes.
• 36:41
  Dr. Emmie Strassberg: And it's fine to have ones that you don't know, but you know, yeah.
• 36:43
  Dr. Emmie Strassberg: A good place to start.
• 36:44
  Dr. Komal Patil-Sisodia: Absolutely, absolutely.
• 36:45
  Dr. Komal Patil-Sisodia: Well, the people of Virginia and Alaska are very lucky to have you seeing patients there., I will, link your website.
• 36:54
  Dr. Komal Patil-Sisodia: And then can you also list your socials for where people can find you online?
• 36:59
  Dr. Komal Patil-Sisodia: Oh yeah.
• 36:59
  Dr. Komal Patil-Sisodia: 'cause I watched your content and you put out some really great videos for stuff that women need to know going into, preconception planning and pregnancy planning.
• 37:07
  Dr. Komal Patil-Sisodia: So.
• 37:09
  Dr. Emmie Strassberg: Yeah, my, Instagram and TikTok handles are Dr.
• 37:12
  Dr. Emmie Strassberg: Emmie Strassberg, all one word.
• 37:14
  Dr. Emmie Strassberg: Yeah.
• 37:14
  Dr. Emmie Strassberg: And my website's dr Emmie Strassberg.com.
• 37:17
  Dr. Emmie Strassberg: So pretty easy to find all of those.
• 37:18
  Dr. Emmie Strassberg: Love
• 37:18
  Dr. Komal Patil-Sisodia: it.
• 37:20
  Dr. Komal Patil-Sisodia: Okay.
• 37:21
  Dr. Komal Patil-Sisodia: Alright, well I will go ahead and make sure we link all of that.
• 37:24
  Dr. Komal Patil-Sisodia: So people can find you.
• 37:25
  Dr. Komal Patil-Sisodia: Thank you again for taking the time.
• 37:27
  Dr. Komal Patil-Sisodia: Yeah, thank you so much to be here.
• 37:28
  Dr. Komal Patil-Sisodia: I think that what you're doing is such a gift to women and your patients and, counseling clients are going to be very, very lucky to have you in their corner.
• 37:37
  Dr. Komal Patil-Sisodia: So thank you and everyone, thanks for tuning in.
• 37:40
  Dr. Komal Patil-Sisodia: I will see you on the next episode.