What to Know Down Below™
Welcome to What to Know Down Below™ by Tina’s Wish! We’re here to empower you with the knowledge and tools you need to advocate for your own gynecologic health.
Knowledge is power, and we encourage everyone to join us in learning more about what you need to know, down below!
What to Know Down Below™
What is Perimenopause? Featuring Dr. Shieva Ghofrany
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Featuring Dr. Shieva Ghofrany, OBGYN & Co-founder of Tribe Called V, and moderated by Meaghan Repko DeShong, Tina's Wish Board Member & Partner at Joele Frank, Wilkinson Brimmer Katcher.
Learn more about Dr. Ghofrany at:
https://www.instagram.com/drshievag/
https://telleveryamazinglady.org/
https://www.tribecalledv.com/
Welcome to what to Know Down Below. By Tina's Wish, we're here to empower you with the knowledge and tools you need to advocate for your own gynecologic health. Knowledge is power, and we encourage everyone to join us in learning more about what you need to know down below to know down below.
Speaker 2Hi everybody, my name is Megan Repko-Dushong and I am excited to be back here to host another episode of.
Speaker 2What to Know Down Below. I am a board member of Tina's Wish and I am passionate about gynecologic cancers and health, but most importantly, finding early detection for ovarian cancer, which is what Tina's Wish really stands for. But why not educate everyone that we possibly can about the importance of gynecological health and different cancers and other issues that may arise in a gynecologic way? And so I'm so happy to be back with one of my favorite doctors, dr Shiva Gofrani. Welcome, dr Gofrani. Hi, how are you? I'm great. I wanted to give you a little opportunity here because last time I feel like I brewed right over it and we need to tell the audience here why you are so amazing. So I want you to give a little intro of yourself and why we love you here and what to know down below.
Speaker 3Thank you. I have to say how I'm amazing. No, thank you. First of all, I love being here. I mean I feel like last time we had so much fun and we could have talked for hours, which is often the case because women's health gets ignored and women experience women's health every single day and, as I keep saying, we all have overlapping Venn diagrams of multiple you know 10 to 20 issues that women go through. They all tend to overlap. So I am Shiva Gofrani.
Speaker 3I'm an OBGYN since 1999, in general private practice for the most part, though recently I've specialized a little bit more in perimenopause and menopause because I am a 55-year-old postmenopausal person myself, because I had ovarian cancer when I was 46 years old, which was kind of the culmination of a lot of OBGYN health issues that I'd had.
Speaker 3I had recurrent miscarriages, I had both kinds of deliveries, I had endometriosis, I had HPV, I had weight loss surgery and then I had ovarian cancer and all of it sucked and all of it also helped teach me, even more than my medical training, how to kind of get inside the mindset of what happens. So I think there's the importance of the medical aspects of what women go through and then the emotional and psychological aspects, which actually I think are equally important. And then I'm lucky enough to be the board president of Tell Every Amazing Lady, which is a smaller ovarian cancer nonprofit that has partnered with Tina's Wish at times, and so I think the collaborative effort is really synergistic because we are kind of grassroots, wanting to help people immediately when they're diagnosed with their cancer or their family members, and understanding things like genetics or how to get into clinical trials. So we love what Tina's Witch is doing and trying to educate. So I appreciate being here.
Speaker 2Well, thank you, we love having you. So today we are diving into a topic that I feel like is actually talked about more in recent times, but not really, I think, to every audience. That should probably hear it, because it might be targeted, and I think having younger audiences kind of know about perimenopause and we're also going to talk about menopause later but talking about these kind of stages that one can go through in their life is really important and almost to like know what to expect and kind of understand a little bit more about it, and so I'm well I'm sure people aren't thrilled to talk about it. I really am, because I feel like it's something that I want more information about, and I know so many people that do too, and I think having a nice safe space where we can have a conversation about it is always welcomed and appreciated. So let's dive in.
Speaker 2So to start, because I think even I don't know how long, but like I didn't really know about perimenopause until a few years ago, I really always just thought it was menopause. So I guess I'm curious. First question how is perimenopause different from menopause?
Speaker 3Okay, so many good questions, so many parts that we could like attack and describe in this. First of all, I would love to say this I think what you said hits an L in the head. It's very natural for a lot of people to be like, oh, I don't to talk about it because, again, most of the things that affect us as women in our ob, gyn health are just at best unpleasant and at worst like really sucky, right? I mean periods at best unpleasant and at worst sucky. So periods trying to get pregnant, worrying about pregnancy loss, trying to not get pregnant and contraception, and then perimenopause and menopause and then all the other things that could happen, like you know endomet endometriosis, hpv, polycystic ovary syndrome. So I think that in an ideal world we wouldn't have to deal with it. In the real world there is zero women I know who have gotten through life unscathed by not all those things, but at least some of those things, as I keep saying, even if it's at best just a regular period that leads you to a regular pregnancy, regular lactation and regular perimenopause and menopause, it still sucks, right. So I say that because I think that we should keep talking about it and talk about it not kind of like silly, lighthearted, but with the air of we want to preemptively introduce all these concepts, ideally before you have gone through it, so that you've heard of it. There's that little nugget in the back of your mind. You might not fully understand it, but then, once you're going through it, you're like, ah, wait a minute Now. Now I really get what's happening Right, yep. So I think again, preemptive knowledge is absolutely what every person needs, whether or not they realize they need it, and that once they've heard things then they can kind of dip their toe into it with less anxiety. So that's like the umbrella with which I think we should talk about all of these women's health issues.
Speaker 3So the big difference between perimenopause and menopause is that menopause is literally defined as that moment in time where you've had one year with no period, which is actually not the way we tend to use the term. Most people, when they say menopause, they either mean the whole transition that leads to that one moment, or they mean they're done with their period completely, which on average would happen at 51. That's when menopause happens. So the definitions are confusing. But what I always say is let's start with the definition of menopause. It's one year with no period after which you are technically post-menopausal again. A lot of people will including myself for ease of discussion will say things like oh, I'm menopausal, when what I really mean is I'm post-menopausal. Or people will say, oh, I'm menopausal when they really mean like I'm going through the transition of my hormones fluctuating, but I haven't yet found my period.
Speaker 3So you see how it's confusing already, right.
Speaker 3But, again menopause one year with no period.
Speaker 3Everything after is post-menopausal Prior, once your hormones start to fluctuate and not do that nice kind of regular, predictable sine wave where you ovulate and then get a period and ovulate and then get a period.
Speaker 3That's perimenopause, which can start as early as your 30s to 40s, because even though the average woman will go through menopause at 51, the range that is considered normal is anywhere from 45 to 55, to again have had your last period and become postmenopausal and perimenopause means your ovaries are starting to fluctuate their hormones and that can start 10 years before menopause. So if you do the math, that means as early as like 35 to 39, you might be starting hormone fluctuations. It doesn't mean you can't get pregnant. People can still get pregnant because they're still ovulating. They're just potentially ovulating either less regularly, less frequently, or the quality of the hormones around ovulation are different, and it can go along with a host of symptoms that we'll talk about. But again, that's the big difference between perimenopause is a period of time leading to that one day where you've had a year with no period and after that you're postmenopausal.
Speaker 2So I feel like perimenopause is almost worse.
Speaker 1Yes.
Speaker 2For like the body and the feelings and the whole thing, yes, and like we just talk about it as like menopause, but now we're actually like defining it more and really explaining that like and it's. I think the other thing is and I could be wrong, but like you know people who don't go through this, are you know men or whatever right? Like it's almost sometimes, as a female, hard to explain. Like I can't predict the day it's going to happen.
Speaker 3And I can't predict the day it's going to end Well and you again, so we can file that under the sucky folder right.
Speaker 3The sucky folder right right, right, like it's going to happen. But it's sucky and just to frame it. You're totally right, meaning you can't predict what is going to happen, you can't predict how it's going to happen. And here's the really sucky part. I always say it's predictably unpredictable Just when Megan might be like, oh, now I got it. Now, the last three months I felt lousy on this.
Speaker 3You know, things are back to normal. Just when you think you figured out a pattern, all of a sudden it might change. And that's the problem with perimenopause is that it is very unpredictable by definition. So that means you know, week to week, day to day, month to month, year to year, your perimenopausal symptoms may change and they may be different than your sister's or your best friend. Just when you think you figured it out, it may change again. But we can actually help with all the symptoms. So it's first of all really important to know that, because you're not crazy, it's just perimenopause. But just perimenopause can make you feel lousy, so we can address it.
Speaker 3The other part is, like you said, we haven't talked about it for so long and it happens to hit at a time in our lives where we're getting into our mid to late 30s to early 40s. That's the stretch where either we have maybe finished having children, maybe we haven't had children and we've had struggles like you and I have had, and we're trying to decide to grow our family, maybe we've chosen to never have children or couldn't have children. That brings on its own psychological issues just in the society we live in. Plus, we're at a time in our careers where maybe we're kind of deciding to pivot. We might be having elderly parents. We're going through all of this stuff right when we're feeling our most lousy, in a way, and right when society has historically kind of wanted us to feel like we're a little bit over the hill or irrelevant, whereas I mean, I would say, at 55, I feel completely not irrelevant, I feel very relevant, and so I do think the conversation is changing, thank God, and we're starting to really address it. So that's the good news.
Speaker 3The bad news is that we've had centuries of ignoring it, and so there are still there's still so much work to be done to get clinicians I mean OBGYNs I'm sure you've heard the data get very little training in residency about perimenopause and menopause, which is bonkers because it's an incredibly important part of our lives, and so there's still a lot of just, you know patriarchy about it, like a lot of patting on the back, and that's not just from men, it's from women doing this to each other, saying like well, I got through it, you should too.
Speaker 3Or oh, you know the whole like suck it up buttercup idea. So there is stuff that we can do, and the reason I kind of expressed glee when you said, wait, it sounds like perimenopause is worse than menopause is not because it is worse, because you're right, it is worse. There's no glee in it being worse. The glee is at least the lousy part precedes, and then you do have a light at the end of the tunnel. Once you become postmenopausal it's not as though everything's okay. You have to make sure that you address health and symptom concerns, but it's more predictable. It is much easier for me to treat a post-menopausal patient than a perimenopausal patient.
Speaker 2That's interesting because that's actually where I was going to go, which is I may go to my OBGYN and say here's all the symptoms I'm feeling, and they're again. It sounds like someone's having a bad day, right, but you're like it's over and over and over again right, and so, and it kind of reminds me of like ovarian cancer, where there's very typical like things that can be easily dismissed, but like, okay, wait, let's take a step back. I have to put all the pieces together as a doctor, right, and say, okay, this person is probably or maybe going through the perimenopausal state in life. And so if, if, like a patient comes and tells you okay, here's everything I'm feeling, right, and you're like thing, okay, I can kind of guess what's going on here. What are the next steps? What can someone do, or what can I? Let's start off actually with what can a doctor. Let's start off actually with what can a doctor do to help, and then we'll get to the patient side of what they can do.
Speaker 3Well, I mean, and I don't I don't want to say this to sound condescending to my fellow clinicians, because I think that's unfair of me but I would say the first thing clinicians can do and I say clinicians as opposed to doctors, because it's doctors, nurse practitioners, pas, who are really seeing these patients right now the first thing they can do is educate themselves and recognize that we didn't get educated in residency and it's not our fault, it's the system's fault. But educate ourselves, because we do owe it to our patients to learn about it, even though it's hard, because you have to learn on your own time, on your own dime, take classes on your own, things like that but first and foremost, educate yourself. And if you don't have time or the inclination which is also okay there are a lot of things that I can't and don't want to treat, but I should recognize that and then I should refer my patient out. So, first of all, it's the humility of knowing we didn't learn it, we need to learn it, or we need to recognize that we should send our patients to people who have learned it or want to learn it, and I don't think there should be any shame in that.
Speaker 3I think the current model is very hard. With OBGYN you get 15 minutes per patient. How?
Speaker 1can you address all these things.
Speaker 3It's crazy. So that's first and foremost. Second is, I just still scratch my head at like why is this so challenging? If a patient walks into my office and she's in her mid thirties is a little different, but certainly by late thirties to early forties and she says in her mid-30s is a little different, but certainly by late 30s to early 40s and she says I kind of have to talk to you about some things that are happening, I can already predict that she's likely going to tell me some.
Speaker 3There's going to be some parts of this laundry list that she's going to complain about. She's either going to say I'm feeling brain fog, I'm tired, I'm moody, I feel filled with rage, I have some hot flashes, some night sweats, some sleep disorders, my libido sucks, it hurts when I have sex, if I even want to have sex. My period might be irregular, it might be heavier or lighter, or longer or shorter, and those are just like the basics. Then on top of it, there's like breast tenderness, ovulation pain, less hair on your head, more hair on your chin, more acne. I mean again a laundry list of symptoms. If she gives me any of these symptoms, even if it's just I'm not sleeping as well at night.
Speaker 3I should, to me, default to it's probably perimenopause. But we need to systematically rule out a few other very simple, very common medical conditions that will overlap with perimenopause. Once we've ruled those out, then we default to okay, will overlap with perimenopause. Once we've ruled those out, then we default to okay, it's probably perimenopause. I cannot prove perimenopause. I don't have a test for it, despite what some clinicians will believe or say or do or charge for. There is no one blood test, urine test, saliva test, nothing.
Speaker 2So it's not even a hormonal blood test.
Speaker 3Not a hormonal blood test, because the way our female hormones work is that they rise and fall throughout your cycle, which is, you know, 28 to whatever day cycle. And remember, like I said, they can change week to week, month to month, year to year. So there's no predicting. So even if I check you right now, your blood work, because of the range of hormones and because of how they fluctuate, might come back telling me that you're in the postmenopausal range, when in fact it just means this month you didn't ovulate, and that would mislead you into thinking you're in early menopause, when you're not. Or it will come back saying you're in the normal range, which just means someone who is ovulating, but you still feel lousy because that month's ovulation was a different quality. And so now you're misled into thinking, oh my God, I feel lousy. She's telling me it's normal, there must be something else wrong. Or you think she doesn't know what she's talking about and she's gaslighting me. So again, there is no one blood test. I wish there were, I wish I could say in the future we'll find one. But we really can't, unless our knowledge changes about it, because we know inherently the hormones fluctuate right Now. Some people say well, what about those tests where you see the hormones through the course of the month, for, like, saliva or urine testing? And the answer is you can do it if you want some kind of confirmation to what I'm telling you with your symptoms. But the truth is those hormone tests are expensive and next month might be very different, so it doesn't help direct treatment. So, again, we all have to understand your hormones can fluctuate.
Speaker 3I still need to rule certain things out, like thyroid conditions, like anemia. A lot of women are iron deficient but their initial blood test shows up as normal because we only screen for something called hemoglobin. We don't screen with an iron test or a ferritin test in routine blood work. And again, that's for a lot of different good and bad medical reasons, right, some of which are insurance based.
Speaker 3We need to make sure your vitamin D3 is okay and your B vitamin. So these are some very basic things that we can rule out that can mimic or exacerbate your symptoms. So I do think there is a lot of help that can be done and there's certainly a lot of different ways to treat people who are perimenopausal, part of which is their own habits, right, like certain things that you and I can do can exacerbate or help our symptoms, and then certain medications or hormones or treatments you can do can improve your symptoms. So there's a lot of help on the horizon. You just have to be patient as the patient to understand that it's a process, and you have to find the right clinician who will be patient with you through the process.
Speaker 2Right. So, speaking of which, so that kind of leads me to from the doctor's perspective, there's hormonal therapy, right? That, like I've read about, yeah, I. So I personally have an appointment with my OBGYN soon and I plan on being like, listen, here's how I'm feeling. I might not fall in the bucket, but things may get ruled out. But let's say I do fall in that bucket. Hormonal therapy what does that actually mean? Because I think also it it can sound scary, especially to someone who went through IVF and went through the like hormone like rollercoaster of an IVF situation. So I know they're powerful, I know they can work and kind of be set up to do what they need to do, but I think it can be scary to sort of think about.
Speaker 3Yeah Well, and that's for some, unfortunately, good and bad reasons. I mean, the good or bad is that we had a big scare back in 2002 when that big study came out, the Women's Health Initiative, which was the study that was widespread and excellent work, but looked at hormone replacement in postmenopausal women and basically the conclusion that was erroneous. Essentially they miscalculated or misrepresented some of the data and scared women into thinking that hormones cause breast cancer and so millions, literally millions of women were taken off their hormones in 2002. And that's what's led to now two and a half decades of women being scared of hormones and doctors being scared of hormones, and that could be an entire episode.
Speaker 2We have hormones in our body.
Speaker 3And so there's a lot of reasons why that study gets a lot of good attention. It gave us a lot of good information, but a lot of the information was misinterpreted and again, women were taken off their hormones, which has led to two and a half decades still of us constantly trying to debunk the fear of oh my God, but hormones are bad because they cause cancer or heart attack or blood clot or stroke. And it's not that none of that is true. It's that the answer is much more nuanced and in fact, hormones can improve heart attack, stroke, they can decrease the risk of breast cancer when estrogen was taken alone. So there's a lot of nuances to that study, but that's because that's why there's fear. Now when we talk about hormones, especially in perimenopause, it's even more complicated than postmenopausally Because remember, like we keep saying, your own hormones are like going up and down and up and down.
Speaker 3So for me to try to control your erratic hormones is much harder than for me to replete the hormones that have stopped altogether, which is what happens in postmenopause, right? So if you came to me and said no period for a year, I'm feeling like crap. I have hot flashes, night sweats easy peasy, I can. As long as you don't have a glaring risk factor, meaning an active breast cancer, active blood clot, active stroke, then I can treat you with estrogen and progesterone very safely and not only make you feel better but in many ways improve a lot of long-term health outcomes, in particular osteoporosis prevention and fracture risk prevention and probably dementia and cardiovascular issues. So there's great things about hormones. They shouldn't be scary. When it comes to being perimenopausal, it's a lot more complicated because again, your hormones are battling against us.
Speaker 2So, the traditional way to.
Speaker 3It's a moving target, and so the traditional way to treat perimenopause was to put patients on birth control pills, because birth control pill doses are much higher than hormone replacement doses. They suppress ovulation, so by suppressing it they basically even out that erratic nature. Great. So that means, instead of me feeling all over the place and moody and having irregular periods and all these things, I'm going to be even. Isn't that great? And it provides birth control because you can still get pregnant during perimenopause. The answer is yes, it is great, but we've learned that, first of all, what we kind of knew clinically was not every woman feels great on birth control pills, and so being completely even right. So being completely even can be helpful for certain things, but doesn't feel great for other things, and it's probably because those are synthetic hormones as opposed to the newer types that we use, which are called bioidentical, which means the newer hormones we use tend to mimic our own regular hormones a little bit more closely.
Speaker 2Don't you see this? Though? People are focused on a 2002 study, we're now in 2025. Science and medicine are amazing when they're allowed to do what they're allowed. To me, medicine is like one of the most fascinating things in the world and we're like hung up on that when, like all the work that's been done to provide, like I know, and there's so much good data to show that that study's interpretation, the study wasn't flawed, the interpretation was deeply flawed.
Speaker 3It's actually a fascinating story.
Speaker 2People always go to the bad news, part right.
Speaker 3Bad news, and it was largely the media that actually created this horrible response to that study. So you're right. I mean, and now we have two plus decades of really good, supportive information as to how to treat patients in perimenopause. One way I'd still advocate for is birth control pills, because they can be really effective for some women. The other way that we're learning about more and more and that many of us are using more and more is hormone replacement doses to help women in perimenopause.
Speaker 3But again, here's the glitch. It's finicky because, like we keep talking about, your hormones change, so it's harder to treat you a little bit with hormone replacement doses because we're battling your own hormones. It takes more finesse, it takes more of a back and forth discussion between a doctor and a patient. It's not an easy like here. Just take this and come back in a year and what do you and I, as doctor and patients, not have together? Is time right?
Speaker 3So you need to find a doctor, unfortunately, that understands it. And then you as the patient, need to recognize that it's not her fault that she can't spend more than 15 to 20 minutes with you if she takes insurance. So either you have to have the luxury of paying out of pocket, or you have to go back multiple times for multiple visits, which, yes, is annoying, but the doctors don't make the rules Worth it Right. So go back multiple times because you have to recognize this is a process, a process of educating yourself and then figuring out what works and then tweaking it Because what what you might try this month might not work at all. You might need a couple of months. You might accommodate, you might think it works great, and then, six months later, your body changes again.
Speaker 3But that's what I was going to say Moving target, it doesn't stop.
Speaker 2So it's like yeah, yeah, you're okay. So then, because I before we like close on this, so we have a few more minutes, but I think there's two really important things I want to cover. One is what can a patient do to help themselves? You kind of touched on a couple of some symptoms, because we've kind of hit on some of them, but there's actually a couple that I think are really important and nobody talks about, and I want to talk about them, Okay.
Speaker 3Well, and first to educate themselves. I mean listening to podcasts like this, going to menopausesocietyorg, which is the kind of prevailing educational system that we have for menopause. It's wonderful. Of course there's some flaws in it, but overall it's a great website and there's a lot of education on there and referrals to practitioners. And then, like in our case, tell every amazing lady we recognize, just like you guys do, that surgical menopause, which is a whole nother thing that so many of your listeners are going to have gone through because of ovarian cancer or other cancers or prevention of breast cancer in the future, things like that. They fall into a separate category where they're very scared of hormones, but in fact they are the ones who will benefit, and sometimes the most, and have an easier time because they already have had their ovaries removed and so we can not have to deal with the fluctuation. So educate themselves. Listening to podcasts like this, going to tell every amazing lady going to Tina's Wish, really learning about it.
Speaker 3And unfortunately you can't fully rely on your doctor to educate you, because even the doctors who want to educate like I joke, I talk fast and I talk a lot, but there's no way for me to have enough time with every single patient to educate, so some of it has to be on the patient side, which I hate.
Speaker 3It makes me sad because it's a challenging world out there, because there's a lot of misinformation as well. There's a lot of people are taking a lot of advantage of the fact that women right now feel vulnerable and want to learn. So there's a big cash grab of programs that are trying to sell you products that will make you believe that they can fix you with one thing. So I would. My one word of caution is if you find a supplement that says it's going to help with all of your symptoms, including your bloating and your weight gain and your libido and everything, please do not buy it, because I will guarantee you that one supplement will not do it all. The closest thing that might help the most is hormone replacement, and even that is not a to help everything and comes with risks. So please, please, please avoid I don't care how famous the actress is who tries to tout any product you want to buy Do not buy those products.
Speaker 2Right, they're getting paid to tell you that. But you mentioned like vitamin D and, like I know, I personally am like vitamin D deficient all the time I take vitamin D every single day. It's like one of the most important vitamins I take because I'm pale and I don't like the sun and I don't want skin care Like it's, like you know. So I also work all the time Like yeah you're indoors and you're not walking around naked in the sun.
Speaker 3So you're vitamin D deficient.
Speaker 2I'm not doing that anymore you know, at 14,. I thought it was really cool, but I'm probably I'm going to probably pay for that. So, um, but you know, it's like so much office time and all this time that we are inside and doing all these things. So, vitamin D, are there other things that are like and I'm not saying it's cure, by any means there's no curing right. It's like how to help someone through a process right, that's really what we're doing or you're doing.
Speaker 2I shouldn't say we cause I'm not doing any of that, but like what could I be doing? Also, in addition to like my vitamin D or anything else, are there dietary things? Are there kind of any of those types of things that I should take into account that are like, really I can control?
Speaker 3Yes, I mean and again, there's so much more we could discuss in more detail, but in a nutshell, it's good. I would get your vitamin D3 checked and talk to your doctor about your vitamin D3 levels, Cause most of us are deficient because we're not walking around naked in the sun, Right, Many of us take magnesium because it can help with sleep and anxiety and bowel movements and all kinds of things that afflict us. So those are kind of two easy ones for a lot of people to try. I know everyone's heard about this and I know perimenopausal women are sick of hearing it, but we can't say it enough.
Speaker 3We need to be better about increasing our protein intake and increasing our muscle mass, because we will lose muscle mass starting in our 30s and certainly postmenopausally, and losing muscle mass leads to osteoporosis. Losing muscle mass can change things, even like dementia risk. So longevity really relies on good muscle mass, like being skinny and small, like I was taught in the 70s and 80s and failed at it miserably, was terrible and the wrong thing. So increase your protein intake, increase your weight training not necessarily aerobic exercise, but weight training. So those are simple things. And then, from the symptom perspective, many people will notice me included that when I have more sugar, alcohol and I used to say caffeine, though my caffeine tolerance is actually pretty good now but caffeine, alcohol and sugar are three triggers for a lot of people for disordered sleep and for hot flashes and night sweats. So those are kind of the that's like the umbrella, simple overview and listen, those are just good health things in general for men and women, regardless of perimenopause and menopause.
Speaker 2Yeah, Totally agree. Okay, so here's the one question, and again, I know we're a little bit long on time, but I think this is really important because again, there's all this stuff that, like, we talk about.
Speaker 2But, like me personally, I feel like this is this should be my prime time, right, like I, I like aging, I think I gain knowledge, I learn and I grow and I'm I am open to hearing other people's views. I might not agree with them, but what can I learn from them? Like all these different things, right, yeah. Yeah, you know, I would not be so open to other people's things, right, because I was like, oh, I know everything, yeah, and it's like very empowering to be, like I don't know this Um, but I want to talk about libido and sexual health because I think it's something that people don't talk about.
Speaker 2We talked about like, oh, what supplements can I take? What can I do? But like we're all in, like you know, there's some of us that are in healthy relationships that want like this is the time to be, like living it up and thriving, and like having you know whether it's one partner or multiple, as long as you're being safe, um, all these other things like how do you like? To me, I feel like that is something that this kind of stage in life can really impact.
Speaker 3Yes, yeah, for better or for worse, right? I mean, I think a lot of women here like oh, perimenopause is a time where women are dying to have sex and for some women, their hormone fluctuation actually does trigger them to want to have more sex. Interestingly I would say, anecdotally at least it seems to be more true in people who have new partners. So when you think about it once you're in your 40s to 50s, many women are kind of like do I want to be with the person I've been with for a long time? They might separate or divorce. They're in a new relationship. So it's probably more the newness of their relationship, maybe, than their hormonal fluctuation leading them to want to have sex. That's the smaller subset. I'm excited For those of us who may have been in long-term relationships where we love them but we're going through hormonal fluctuations or no hormones.
Speaker 3If we're post-menopausal, we know that as estrogen and progesterone fluctuate and go down, testosterone also goes down and we've created this criminal situation where we've gendered hormones and we say estrogen and progesterone are female hormones and testosterone is a male hormone. But we repeat this a lot nowadays. I don't know if you know this. We have more testosterone in our system than estrogen. So as our testosterone starts to go down, we will notice a host of things like, again, muscle atrophy, weakness, brain fog, all these things that are also related to testosterone, not just estrogen Plus.
Speaker 3Estrogen is actually derived from testosterone, so the next way is that we are learning more about that. We are teaching more about that. Luckily, we're going to start treating more women with is testosterone safely, in safe doses, not like anabolic steroids back in the 80s, where people were bulking up and like getting acne and hair on their face, but appropriate doses to restore their testosterone to the normal level, so that they can feel vital and strong and have more of those feelings of desire and the ability to have an orgasm out of those things. It's not as though like, oh my God, give me testosterone, I'm going to be horny all day, but it really can help women because they globally feel better and it can help their libido Because again you might know this there are not a lot of medications out there for female libido, whereas there are 26, I think.
Speaker 1FDA approved for male.
Speaker 3Right. So erectile dysfunction gets a ton of press and it's called dysfunction, even though it's actually quite normal for men to go through it, Whereas for us it's like that's just part of the part of the process. So I think there's a lot, once again, there's a lot of preemptive education that can go into women understanding libido, women understanding how libido works for people who are assigned female at birth and how our spontaneous what spontaneous desire is versus receptive desire, like all these concepts that most women, even very educated women, don't know about, and just learning about them make them feel like, oh my God, I'm not broken, I'm normal, this is okay and I can help address it and fix it.
Speaker 2Like I want to keep reminding women that their partner. Yeah, oh, absolutely, and that's where I think there can be right, like it can cause. It's not just the female or the oh, not at all, like that's going through this, it's if, if there is a relationship involved, like both parties can feel it Right and men don't understand it.
Speaker 3It's not their fault, but they have not been taught and they have, you know, they have been taught the same thing we have, which we should all be wanting to have sex. And if we don't, there's something wrong with the relationship, or we're not attracted to each other or we're broken. So there is a lot of education that needs to go behind it, and we we need to keep reminding ourselves and each other as women, all these things can be natural and normal, and yet we can also fight against nature, as we do every day by prolonging our lives. We've already done that, and so it's okay to go against it. It's also okay to accept it, if you want to accept it. There's nothing wrong with that either. We should kind of normalize all of it so that people get it.
Speaker 2Right, no, that's amazing. Well, dr Gofrani, thank you so much for joining us again and sharing your expertise with us today. I love speaking to you and I think I hope our listeners love hearing us, because I think we do put it out kind of as it should be, which is plain and simple and kind of to the point. Which is plain and simple and kind of to the point. You know, if our listeners you know we taught you something, we inspired you to take action to prioritize your gynecological health, we'd love to hear from you. Leave us a comment below or send us a message on Instagram at Tina's Wish or Dr Goffredi.
Speaker 3Instagram Dr Shiva G or on my website, dr Shiva Gcom.
Speaker 2And don't forget to like, follow or subscribe wherever you listen to podcasts, so you never miss an episode of what to know down below, and be sure to tune into our next episode, where Dr Gofrani and I will be discussing what comes after perimenopause menopause.
Speaker 1Thank you. Thank you For more information about gynecologic health. Visit tinaswishorg slash. What to know, that's tinaswishorg slash. W-h-a-t-t-o-k-n-o-w. And like, follow or subscribe, wherever you listen to your favorite podcasts.