Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Celebrating Women’s Health Month: Are You Prioritizing Your Health?
This episode celebrates Women’s Health Month by emphasizing awareness, education, and empowerment in women's healthcare. Join Dr. Holly Thacker as she discusses essential health topics, from vital screenings and nutrients to effective self-advocacy during medical visits.
In addition to physical health, this episode highlights the significance of mental wellness, advocating for the self-care of women who often prioritize the needs of others over their own well-being.
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Executive Director of Speaking of Women's Health, and I'm back in our sunflower house for a new podcast on Speaking of Women's Health, and this is the month of May. It's a very important Women's Health Month for so many different reasons. What we're going to talk about today is National Women's Health Awareness Month, and so it's fitting that we at Speaking of Women's Health celebrate this and talk about women's health. And who's better to talk about this topic than us, our team at Speaking of Women's Health, a nonprofit that is dedicated to empowering you to be strong, be healthy and be in charge empowering you to be strong, be healthy and be in charge.
Speaker 1:So May starts out with May Day May 1st ring around the roses. We have Mother's Day, which is a special holiday for all moms. It's Nurse Appreciation Month as well. We have fabulous nurses in our Specialized Women's Health Center, and it's great that there is a celebration and attention on women's health during the month of May, and this recognizes the physical and mental health concerns of American women. And, interestingly, it was the National Cervical Cancer Coalition, the NCC, that recognized each May as Women's Health Month, and so the official observation kicks off every year around May 11th through the 17th. So May is such a busy month Mother's Day, nurse Appreciation, and it's also Osteoporosis Awareness Month, and we feel very fortunate to have received awards related to our osteoporosis health topics.
Speaker 1:On speaking of women's health, and so, if you haven't listened to our podcast interviews with osteoporosis experts, information on prevention, treatment evaluation, newer therapies, questions with our nurse, if you're someone who is contemplating osteoanabolic bone building therapy, or if you just have questions about calcium and vitamin D and general musculoskeletal health, we have it all. So be sure to go on our website under podcast and you can search for different topics. To come up with the exact date of a podcast that you might have missed and so as to not miss podcasts, hit the subscribe or follow button. I have so many patients and friends say, oh, I was listening to this podcast. I haven't listened to it recently. I'm like, well, did you hit subscribe? I mean, we're all very busy and sometimes time gets away from us, but if it's an important topic, which hopefully women's health is to all of you, it's important not to miss anything.
Speaker 1:This is also the time that there is actually an annual observance that was pioneered by our United States Department of Health and Human Services Office on Women's Health. So HHS is a big part of the federal government, about 25% of the budget, and there is a special office on women's health. So the goal of this holiday, so to speak the goal of this holiday, so to speak, is to empower women in such a way that they can make health a priority, and it also equips women with knowledge to help other women on their journey to improve health and with the efforts of individuals and healthcare clinicians individuals and healthcare clinicians we want every woman to live a healthy and happy life. So what are some of the activities that occur during Women's Health Week? Well, this alliance of government organizations help to raise awareness and education about proactive steps that women can take to improve their health, because we have lots of concerns about the health of the population, about chronic disease in children and women, who are many times at the center of families and communities that care for the young ones as well as some of the other aging individuals in the community. And it's important to empower women to discuss with their healthcare team which particular tests, therapies, evaluations, interventions may or may not be right for them, how often they should have them if they should have them, and also it's important to get full informed consent and not feel like there's anything you absolutely have to do. I mean, I tell my patients that things that I think are somewhat non-negotiable, that are safe and effective and cheap like, say, wearing your seat and not smoking and imbibing chemicals, drugs of abuse, et cetera that seems to be pretty common sense and most all people would agree on that. Everything else there's some choices.
Speaker 1:In terms of screenings, though. The gold standard of cancer evaluation and early detection and treatment to prevent cancer deaths is really the pap smear, and the pap smear, all these decades later, really remain a pinnacle in women's health. And January was cervical cancer awareness month, and I just see with younger women and many midlife women and even older women in my practice being told oh, I don't have a uterus or cervix, I don't need a pap. Maybe you don't, but maybe you do. Oh, I'm over 65. I don't have to do that anymore. Well, if you've had a lifetime of negative cervical cancer screenings maybe you don't, but you may and if you've had abnormal testing, if you've had HPV, if you've had interventions to treat precancers, it needs to be individualized. Now a lot of women think that Now a lot of women think that mammography and breast cancer screening is kind of the pinnacle.
Speaker 1:There's more pitfalls with mammography. There is certainly benefit. It's certainly used as a diagnostic test. It's also used as a screening test and there are different recommendations and you've heard a little bit about differences of opinions on prior podcasts that I've done with medical breast specialist Dr Holly Peterson she calls herself the other Dr Holly and we think that, based on your age, your hormonal status, your personal priorities, your own personal medical history and your family history, it's good to come up with some individualized assessments Now with breast cancer screening.
Speaker 1:If you feel that something's wrong, if you feel a lump, even if you're a young woman, don't let someone blow you off because even though it's maybe unlikely especially if it's new or painful it could be a cyst Just because you're young. If you think something's wrong, you need to get that pursued. There's lots of different recommendations about when to start screening mammography. There's been this big push to digital mammography or three-dimensional mammography, which does entail more radiation. I do have women who don't want to do this.
Speaker 1:Many women want the most amount of imaging possible. Certainly, with mammography we get additional information about breast density and many times the breast technologists may collect information about your reproductive and hormonal history and family history, histories of breast biopsy, and this information and your breast density may give further risk stratifications about your risk for breast cancer. Now it's important to know your family history. Having an older family member of advanced age being diagnosed with breast cancer, particularly on mammography, is not nearly as concerning as a history of breast cancer under the age of 50 that's diagnosed in a first degree relative, or if there's a pattern of cancers breast cancer, ovarian cancer, colon cancer, uterine cancer. So of your blood relatives, it's really important if you can find out medical history and exact diagnosis because you may need genetic testing and those at the very highest risk of breast cancer do need more intensive screening. Now some women are told to get a baseline mammogram at 40 or 45. Some recommend even 50, but women in their 40s and even earlier can have breast cancer, and others have recommended that you should have a yearly mammogram for most all women between 45 and 55 yearly, and then average risk women between the ages of 55 to 75 or so could be screened assuming they have no symptoms every two years or so. Now I always tell women if you're 105 and you have a breast lump, we're going to evaluate you. So there's not an age limit. But just like we change the frequency of cervical cancer screening after you've been screened for decades of your younger and midlife, just as sometimes when a person gets much older, especially if they've had normal colonoscopies, we may move to just Cologuard screenings or less invasive screenings.
Speaker 1:Although my dear aunt, who had multiple colon polyps and every time she had colonoscopies she had precancerous colon polyps removed and she's doing very well, very involved in her community, socializes, has grandchildren, has great grandchildren, is very involved with the church. So on her 80th birthday she went in for a colonoscopy and she had a tubular adenoma, a precancerous colon polyp, and they said oh, you're 80. You don't have to come back for any more colon cancer screenings. Now I wish you would have called me and talked to me about it, because at age 85, she's very vigorous and 86 actually and active and she got really weak and had severe anemia and she had had a lesion, a colon cancer, that was eroding into her bowel and causing bleeding. So much to the fact that she was so weak and needed blood transfusions. Now had she been rescreened another three or four years because of all those precancerous polyps. I think that this could have been stopped and she wouldn't have bled down so much Now. Luckily she was able to get surgery and stop the bleeding and she is significantly recovered.
Speaker 1:But it's very individual. If you're healthy and active and have several more years of lifespan, it doesn't mean that you have to stop screening. And certainly in people that have had abnormal PAPs, who've had breast cancer, who've had colon cancer or precancerous colon polyps assuming that you feel up to having the test done and do not have some other major, severe comorbid problem these really do involve individual discussions. Now, when I see women with hysterectomies on estrogen doing great who are past the age of 75, many of them are 80, 85, 90 year olds in my practice doing great, if they don't have any symptoms in their breast, I don't recommend the screening mammography because there are false positives and if they get a biopsy and it looks abnormal, then they're not going to be able to be on their estrogen, which we know helps with function and longevity, and we have good data that it actually reduces breast cancer even into your 70s. So each type of cancer is different, just like you might be 90 and have a skin lesion that's bothering you and it could be cancer or pre-cancer that should be locally treated. So there's just a hierarchy.
Speaker 1:Not all cancers have as much evidence that early detection makes a difference. Sometimes it's better treatment once the person has the clinical disease. And there are cancers where people can have what looks like clinical disease if you go biopsying the tissue, like the thyroid, like the breast, like the prostate in men. So older men without symptoms. You know we don't recommend just routine PSA screenings, for instance, unless there's symptoms. Again, if you're older you know gentlemen in your family who has symptoms, then of course you want to be evaluated. So screening is not therapy and symptoms require diagnosis. And so ideally to have a screening intervention, it should really only have upside and no downside as much as possible. And there is gradations in this and that's why one size does not fit all and it really does take nuance.
Speaker 1:Now, going back to our gold standard the pap smear. The cervix is the opening of the uterus and we generally now recommend the first pap smear by age 21. Now, certainly before then you may want to of course have a pelvic exam and see a gynecologist or a women's health clinician. Health clinician my niece, who is 20, on synchodomyo 5505, she was born, you know called me up and said, aunt Holly, you know I was at the healthcare center and they didn't say I needed to get a pap smear. But I'm a woman and shouldn't I be evaluated? I said, well, you know, cervical health is very important but you're not yet 21. And what's important is that you get information and pelvic exams. If you have symptoms, you get evaluated. And yes, on your 21st birthday, which won't be until 2026, then you can go in and have your first pap smear and we generally do them every three years.
Speaker 1:After age 30, we add a routine HPV human papilloma virus assessment test. In addition, now, if the HPV is negative, kind of the bottom basement, kind of guidelines, are that? Well, you could go every five years and I don't let my patients usually go that long because I certainly have seen some cases of cervical cancer at the four and a half year mark. So there are such things as false negative tests, just like there's such a thing as false positive test. You know we could get into a statistical discussion about sensitivity and specificity. If you have a very sensitive test, you don't want to miss anything and you may over-diagnose and for some things that may not be as bad, for other things that can actually be kind of pretty bad. Now, specificity if you want a test very, very specific, that means you're not going to have false positives and you're going to actually be fairly confident that if that's your diagnosis, that's the real diagnosis and it's this yin and yang, and knowing what the positive predictive value of a test is is important. And so, really, with any test, there are false positives and there are false negatives, and that's one reason why I tell my patients from 30 to 65 that, in general, if you're an average risk woman not high risk, but average risk I want you to get the scrape of the cervix every three years. Because what if you're at the four, four and a half year mark and your clinician says because what if you're at the four, four and a half year mark and your clinician says, oh, you're not quite due yet it hasn't hit the five year mark. Well, what if you've moved or you forget to make your appointment or you have some other crisis?
Speaker 1:I have seen women who generally are responsible with their health and aren't adverse to going in and seeing a physician and have health insurance, who actually just don't think about it because it's not emphasized as much. Just like I see women determined to get their mammogram when they don't have symptoms and they're a healthy 80 year old traveling the world Like why do you want to have this test done? That's a little bit uncomfortable, that could give you a false positive and lead to you becoming a patient. So again, it's personal choice. I have active, you know women who you know have their 80 and they may easily live till they're 95 and they just want the test. As long as you understand the risk and the benefits. And I think too often we just say, oh, it's screening, so it's all good. You know, it's just like getting a bonus check or extra money in your bank account. Right, that seems all good, although I guess there's taxes potentially. So maybe there still is a downside to most things Once you're 65, then if you've always been negative your whole life and your mother didn't take DES, diethylstilbestrol, which unfortunately was given to pregnant women um to prevent miscarriage and that can be associated with vaginal and cervical cancer If you haven't had abnormal PAPs, leaps, cones, hpv then you don't necessarily have to continue to get the scrape of the cervix, but you still need periodic pelvic exams and generally speaking, you know, medicare covers that annual gynecologic exam, not annually but every two years and for most women without symptoms, generally that is fine.
Speaker 1:Again, has to be individualized based on your history. Again it has to be individualized based on your history Women with HIV, human immunodeficiency virus, women with immunocompromised they're on immunosuppressants, women with abnormal tests, smoking, other complex medical histories we may make different assessments. What's really nice at the Cleveland Clinic is we have a service where if a clinician is not exactly sure what to do with an abnormal PAP or what should be the interval, you know, because some guidelines have some differing opinions and again they're usually the bottom basement recommendations, not necessarily the top tier level of what you may or may not want. And again, more isn't better. So maybe you would want to follow, you know, the more minimalistic evaluation and again some of that has to do with your own, you know, personal values and approach. I mean it'd be nice to be a lot more definitive but we always can't be Certainly.
Speaker 1:If you have smoked, if you've had multiple sexual partners, if you've had known HPV, which is one of the causative agents of cervical cancer, it's not the only one. I mean I do have some women in my practice who have done HPV cervical cancer. It does happen. That's why I'm not really such a big proponent of saying, oh, just only do self-HPV testing. We did talk about that in January on January's podcast. And so for women who otherwise would not seek any exams or health care or don't have access, certainly a self-directed HPV assessment test that the woman collects the swab herself is better than nothing.
Speaker 1:Just like I tell patients and I'm thinking of one of my friends who's a patient, she's listening, she knows who she is she's like I don't have a family history, I'm, you know, 50. And I think I just want the coligard. I really don't want a colonoscopy and I'm like you're like 50, almost 51 and you haven't even had a colonoscopy. Our new guidelines are screen at 45. I said you need at least one colonoscopy and she really didn't want to do it. You know the holidays were coming up, she's busy, you don't work, it's the prep. You got to drink all that fluid. And if you want more information on colorectal cancer screening, then definitely tune into our March of 2024's podcast. You know which marches colorectal cancer awareness. We're seeing definite skyrocketing rates, especially in younger people, and so we've pushed down screening to 45. It used to be 50. A lot of people still think it's 50. It's not, and if you've personally had symptoms or a family history.
Speaker 1:But anyway, getting back to this friend patient, I think I kind of shamed her into it and you know she was very happy she had it done because she had some precancerous colon polyps and you know a and a lesion that was pressing on her bowel that led to other tests that led her to get a low-grade cancer treated and cured and she might and probably not would have had that outcome had she just had the Cologuard. Maybe the Cologuard would have been positive and that would have led to other tests, but maybe by then this tumor could have ruptured. So, um, there is risk though with colonoscopies and, um, you know, if you talk to enough people, somebody will tell you a bad experience. Certainly an inexperienced colonoscopist could rupture a colon. There are diverticula in in people many times who are over 50 and there is that chance of rupturing the colon. It's very, very rare.
Speaker 1:Knock on wood, the only patient I've had in my practice who ever had it done was someone who had a tumor again and that I think was the cause and she wouldn't have known about the tumor and being cured of the tumor, had she not had that complication. So it ended up turning out okay. And so that's why people who've already had a normal colonoscopy and they don't have any symptoms or family history or increased genetic risk like familial polyposis or one of the Lynch syndrome variants or a family history of uterine and colon cancers, that you could do Coligard and there are some other screening tests. So again, it's personal decision and it's a discussion, you know, with your healthcare team. We don't really do the annual hemocult blood testing, um, we don't really do the annual hemocult blood testing. If you have, you know, steak tartar with a little, you know, red meat and blood, it could be falsely positive. Vitamin c can affect it, um, and it can be falsely negative. And by the time you're bleeding from a colon tumor, like I was talking about my lovely dear aunt, um, you know, maybe it's gone a lot farther than you would like it to go. And colonoscopy is one that, if you remove these precancerous colon polyps, most all not all, but most all colon cancer starts in polyps that are there for several years. And I tell all of my patients that it's very important that when somebody removes tissue from your body.
Speaker 1:It's good to keep a hard copy of the pathology report Because you may not be able to locate the records. Just because it's online doesn't mean you're extremely busy. Healthcare clinician has time to check in the thousand different boxes that you can possibly click on. Or sometimes you can click on them and they're so small you can't even really see the details. Or you can see that they had a colonoscopy but you don't know where the pathology is. So keep a copy of it because even though it's benign which I think the average lay person just thinks, ah, it's not cancer. So I'm happy, I want to get back to my life, I don't want to think about this medical stuff and we can't really expect you to understand the lingo always. I mean, we talk so fluently medically doctors and nurses about this, but it's not always secondhand nature.
Speaker 1:It really crystallized to me when my husband was frustrated because one of the eye technicians who was doing his eye exam said what is your blood sugar? And he said I don't know. Let me look at my chart and he's like looking for blood sugar. He knew what his glucose was, which is normal. He knew what his hemoglobin A1C was, which is a measurement of his blood sugar over the last, you know, three months, which was excellent. He knew those numbers, he knew glucose, he knew hemoglobin A1c, but he didn't know blood sugar, which is like more of a colloquial term, and so I have to always remind myself that that. You know, not everybody speaks this language. It's like you know, you know people that are multilingual. It's great when you can speak in a lot of different languages. I only really know English, a little tiny bit of Spanish and a little tiny bit of French, but not enough to be conversational. And so that's how a lot of people are medically they just know a little bit of words but they can't really converse.
Speaker 1:So keep your records, okay, and just because something's a benign polyp doesn't mean you don't need screening. You may even need screening in a couple of years, a year or two, especially if there's not a good colon prep. You may need it in three years if someone removes polyps and tells you, oh, you can go 10 years. I saw a lady today and we were having that discussion and she said, oh, they said 10 years. And I'm like, well, that would be if everything was perfectly clean and they didn't see anything at all and maybe you had already had a colonoscopy prior, but they said that they had. There was still some stool in your colon and they did remove polyps, even though they were benign and hyperplastic. Those aren't as concerning as tubular adenomas, tubular villus adenomas, sessile, serrated polyps, multiple polyps.
Speaker 1:So the next cancer is skin. It's the biggest organ. We have a lot of podcasts on the skin, from dry skin to rosacea to you know, cosmetic help for aging skin. Certainly, sun exposure can increase squamous cell and basal cell and early sunburns. Ironically, though, telling people to slather themselves with sunscreen and not checking their vitamin D or correcting low vitamin D levels from lack of sun exposure can actually increase melanoma and other cancers. So that's why most of my patients and again, this is not medical advice, this is just a show to educate you and entertain you and empower you For most people that are over 40, that live in a northern climate or aren't exposing them their naked skin to some sunlight at the right latitude, generally, unless you eat like an Alaskan, you need vitamin D, and if you didn't listen to podcast number three in season one, all about vitamin D, it's like a miracle pro-sterile hormone. It's not even a classic vitamin. We have lots of ways to protect your skin and sunscreen, but you've got to make sure you're getting your vitamin D Now.
Speaker 1:Other screenings and other tests like screening for sexually transmitted infections. Certainly women under age 25 to 26, certainly under 24, should be checked because if you have some occult case of chlamydia you could have scarring of your tubes and be infertile. You need to be counseled about HIV and sexually transmitted infections, understand symptoms and what your options are. So screening for chlamydia and gonorrhea is something that should be done in high-risk populations, regardless of age. I mean, you might live in the villages in Florida where there can be some pretty wild sexual activity. You can't just only limit it to young women. So again, it's very important to be honest with your physician. It's confidential, it's patient-physician confidentiality. I mean, unless you're going to tell someone that you plan to kill yourself or kill someone else. That's when we, you know, have responsibilities to break that confidentiality.
Speaker 1:But everything about your intimate personal life is important to feel comfortable talking to your healthcare clinician about. I had a new nurse who was rotating with me and wanting to learn about midlife women's health and she was like I'm just, you just were so comfortable and relaxed and it was so nonchalant. You asking you know those very personal questions and that's the way it should be, you know, very comfortable and clinical and what is important to assess for your health. Now pregnancy is a whole other topic. There's lots of screening blood pressure, kidney function, the fetal heart tones, the blood pressure, screening for gestational diabetes. There's a lot of things, you know. Nutrition, early nutrition, having adequate folic acid levels and then early in pregnancy having the right, having enough choline for brain development and the omega-3s and we've got an upcoming podcast on omega-3, which is a really important one, I think.
Speaker 1:Now, menopausal women, you know which is my professional passion and I got interested in it because I thought why, at midlife, when you're just done raising your children and you've established your life and potential career and community involvement, then everything, finally, you can maybe enjoy some things you know in your second beginning of your adulthood. And then boom, I would see women that look like wilted flowers, you know, with hot flashes and sleep problems and brain fog and increased risk for heart disease and osteoporosis. It seemed like so many diseases of aging took root then. So definitely having a cardiovascular risk assessment and osteoporosis risk assessment is very important as part of that risk factor and so much of what we eat and how we live our life and what our exercise is, and avoidance of toxins. Excessive alcohol. Tobacco is very important and I think our food supply is finally getting some attention. And, uh, I did a column and a podcast in season two last fall of 2024 all about things that are banned in other countries, that have just infiltrated, all about things that are banned in other countries, that have just infiltrated our food supply, things that are addictive, things that might make the food look more appealing to young children but might be carcinogenic. So if you didn't listen to that one, please go back, and even if you did, it's really worth a listen.
Speaker 1:Heart disease you know February was our women's heart month, but really every month of the year you need to think about that ticker and your whole cardiovascular system because it is the number one cause of death in American women and even though male sex is a risk factor, you know, for earlier disease, women do catch up and when they lose estrogen things can accelerate. And certainly a bad lifestyle, a family history, smoking, advancing age. In women, hypertension is a bigger issue and you know, women have more atrial fibrillation actually, and knowing what your lipid panel is is not so much, just solely the cholesterol. But I want to know what your triglycerides are, because if your weight is up, your blood pressure is up, your triglycerides are up, your good HDL cholesterol is low, maybe your sugar is creeping up and you have so-called syndrome x or diabesity. That's really a problem and diabetes is a much greater risk for heart disease in women than in men.
Speaker 1:Many times I will get a baseline ultrasensitive CRP in women to further assess inflammation, because that is more of a correlate than actually plain cholesterol and I see a lot of knee-jerk reactions just to prescribe statins, and statins certainly have a role, particularly in established heart disease in women, but there's no real evidence for primary prevention. So you really have to have a good reason to put a 50-something-year-old woman on a statin if she doesn't have any vascular disease. And coronary calcium scores can be helpful. They only show calcified lesions, they don't show everything. So again, one test and one simple assessment may not give the whole picture. Now we can't interpret an ultra-sensitive CRP if you happen to be on oral hormone therapy or oral contraceptives because there's an effect in the liver. That's a secondary phenomenon. It's not real inflammation, but it kind of obscures the test results. And speaking of obscuring test results, including hormones and cardiac tests, is biotin. So if you didn't listen to the podcast I did a few months ago on biotin, that's one to listen to Now.
Speaker 1:Medicines that are proven to reduce cardiovascular risk, including heart attack and stroke generally, are medications in women that already have known disease and so we're talking about. If you've got existing atherosclerosis, you may need a statin. If you have hypertension, you should be treated. Ace inhibitors many times are used. If you have diabetes, you should definitely have it controlled and try to get it into remission, and anti-aging agents like metformin or glucofage can be very helpful, although can go through the kidneys and liver and can lower B12. So, again, everything has risk and benefits that you need to get informed consent, and statins in females have not been shown to be effective against primary prevention of heart disease and in women they increase the risk of diabetes, and I see women every week who are on a statin. They don't have heart disease. Nobody's even checked their hemoglobin A1c, they haven't been doing intermittent fasting or taking the carbs out of their diet, and no one's even counseled them about the benefits of menopausal hormone therapy.
Speaker 1:If you start with healthy arteries, estrogen has a panoply of effects increasing nitric oxide, improving cholesterol ratios, being a mild calcium channel blocker. There's effects genomically and non-genomically. Sometimes sleep is better, so that the person's able to focus and eat right and exercise better than just being miserable with hot flashes. So there is cardiovascular benefit and some longevity promotion that we now have evidence on. Again, one size does not fit all. Nothing is risk-free. There are rare women that can have blood clots, particularly on oral estrogen. There can be annoying side effects with breast tenderness and bleeding. So what works for one woman doesn't work for another and that's why really having an anti-aging, comprehensive midlife physician who understands the importance of all these different domains, looking at you individually, taking into effect your goals and preferences and giving you options and sometimes I say you know you might not know until you try.
Speaker 1:Really, one of the biggest things of most importance is diet and you can control generally what you put in your mouth and having a Mediterranean heart healthy diet, even though I think down the road we'll have more evidence that maybe some diets are better for some people's nutrigenomic profile than others. But right now we do know that the Mediterranean diet heart healthy fats like olive oil, avocado, taking out every trans fat, getting rid of the seed oils, getting rid of sugar and additives and simple carbohydrates. There's no such thing as an essential carbohydrate. There are essential fats omega-3 and 6, and there are several amino acid proteins which are essential, meaning our body cannot make them. Several amino acid proteins which are essential, meaning our body cannot make them. Applepectin flaxseed can lower cholesterol. Garlic one of my favorites my husband always says my perfume of choice is garlic, onions, oat bran and I would much rather someone use butter or lard than seed oils if you're going to be using extra fats. But I really want people to focus on those healthy fats that are good for your brain and your mood and your skin and your heart.
Speaker 1:And the omega-3s are something that so many of my patients are low in. Even when they think that, oh, they eat healthy, they don't really eat junk food. They don't usually eat out too much. They read labels sometimes, but not completely, and when I check those women's levels a lot of times they're really suboptimal. So fatty fish and almonds and walnuts and flaxseed and seaweed and omega-3 eggs. I had a lady today tell me well, I've never seen that I'm like well, just look at the egg label and they'll tell you if the chickens were fed omega-3, then there's omega-3 inside the egg, so those are like the only eggs that I buy. Now.
Speaker 1:Hormone therapy in women who take it for several years, starting within 10 years of menopause or under age 65, it's associated with less cardiovascular disease, less heart attack, less heart failure. But there are some women who hormones, especially oral hormones, make the blood thicker. So if you're generally somebody with no family history, you've had a child or two or so, maybe a C-section, maybe you've been on hormonal contraceptive agents for several decades, that's a much greater risk. But sometimes age and dehydration and other factors. You know there are people who've had hypercoagulability in their life, who never had it until a confluence of other agents happened, and so if there's any concern about blood clot, that's when we usually turn to transdermal estrogen. And women who aren't on systemic estrogen, if they're post-menopausal, can use vaginal estrogen to keep the vagina and bladder healthy and reduce bladder infections. And if you didn't listen to my October 2024 podcast on the incredible large volume of evidence of hormone use various doses, routes in 11 million women in America for 13 years, I mean that's a huge data trove. That was one of my favorite podcasts to do.
Speaker 1:Now women are naturally concerned about breast cancer and really the Women's Health Initiative, which came out saying there was an increased risk if you took PremPro for over five more like 10 years. One extra case per thousand women. There was no increase in deaths and when that study was looked at closer, the placebo group had an abnormally low risk of breast cancer. So there's a lot of us in the menopausal field that don't think there's any increase in a diagnosis, even with estrogen and systemic progestin, and most of us use progestins that aren't as anti-estrogen as medroxyprogesterone acetate. But it is good at protecting the uterus and I do have women on PremPro.
Speaker 1:Again, one size does not fit all, but I sometimes think something gets demonized and someone says, well, just do this, this has no risk if it's a quote bioidentical. I have women try to recite to me a book of a certain Instagram article influencer who you know they read. Well, you should just do this and take continuous transdermal estrogen and progesterone. Well, that's only FDA approved to cycle and oral progesterone is not always well absorbed. I saw another lady today who was on oral progesterone who had pretty bad heartburn, so that wasn't right for her. So what might be good even for your sister or your best friend isn't necessarily what's right for you.
Speaker 1:And probably one of the most highly individualized assessment is really menopause and midlife. It's a little easier to make general recommendations about cervical cancer screening and breast cancer screening and colon cancer screening and skin cancer screening. Screening and skin cancer screening. We still mainly use hormone therapy to treat symptoms. Because if you're treating symptoms you accept a higher, you know, potential risk.
Speaker 1:But everything has risk, even preventive things like an immunization. I've had patients say well, you know, the one time I didn't wear my seatbelt and I was glad I didn't, cause I could get out of the car. So you know, anything that is preventive still potentially may have a risk. Um, like we tell everyone to exercise and walk, well, you know, if you're not careful and you slip and you fall you could crack your skull and, you know, have a subdural hematoma. So again, everything has to be individualized. But at midlife you need a risk for what's your cardiovascular risk? What's your blood sugar, since diabetes is increasing? If you're over 45, that should be checked.
Speaker 1:Colon cancer 45 is an age Within two years of menopause or certainly by age 65, you know your physician or nurse practitioner should have ordered a baseline bone density Sooner if you have other risk factors or a personal history of fracture over age 45. And osteoporosis is such an important topic. Calcium and vitamin D are so important and we have several podcasts that are dedicated to the evaluation and the treatment and the screening what a bone density entails, also assessing if you're at risk for violence intimate partner violence. We're going to have an upcoming podcast on this topic because it affects women of all backgrounds and just having a trusted primary care physician, particularly once you hit midlife, is important and a lot of women who are healthy, who maybe are just having babies or needing contraception or some menstrual assessment, are so used to seeing their OBGYNs and some OBGYNs kind of age with their patients and they start doing more midlife menopausal women's health. I have a lot of OBGYNs transitioning their practice who come and kind of want mini trainings and want to focus their practice and don't necessarily want to be up at three in the morning delivering babies anymore.
Speaker 1:But you know people have very individualized practices. So maybe good for you at one stage in your life but not for another stage in your life and you really want to have a team that you feel comfortable with and so while the OBGYN who delivered your babies will always have a special place in your heart. He or she may not be the one to keep taking care of you after midlife. One place that you can go to look to see if someone has taken a test to get credentialed is the menopauseorg website, the Menopause Society. I know some patients find me that way, some people find me through word of mouth and, of course, find me through physician referral. Unfortunately, there's not as many experts in this field as there should be and I've been running a fellowship, I've done podcasts on the fellowship and we have a lot of different initiatives to try to expand that access for women.
Speaker 1:Immunizations are something that are addressed during different stages of life. Again, it has to be individualized and risk benefit. You have to know what infections you may have had or what your risk factors based on your personal life or your occupation are. But again, that has to be with informed consent and looking at your full picture and generally that is like your long-term primary care team and I want to just wish all the moms and the Mimi, grandmothers and the caregivers out there a very happy Mother's Day and I want to give a shout-out to just the most wonderful nurses that we have. I love our nurses in our Center for Specialized Women's Health.
Speaker 1:It's National Nurses Week, may 6th to May 17th, and I just know that women are often in the business of taking care of everyone except themselves, so that's a no-no. If you're neglecting yourself, so treat yourself to good health care. Pamper yourself If you haven't seen your physician make an appointment. It's easier to cancel an appointment than get one. If you didn't listen to how to get an appointment medical appointment last fall, that's like a critical one and get the screenings and the evaluation that you need and come organized and attentive so that you can focus on what you need to focus on. And maybe you won't be able to get everything taken care of and you may have to break it up into a couple of visits. We in our Center for Specialized Women's Health offer a concierge custom fit cash pay program where that covers the nurse to take in the intake and get things personalized and set up and give a woman a whole hour.
Speaker 1:And I think that sometimes that's like how you fly, like, do you fly first class? My husband likes to do that. He's happy to pay extra money and I would rather sit and coach and save the money because we're all going to get there at the same time. Maybe he'll get off the plane, you know, a minute or two before I do so some of it just depends on your lifestyle and your budget. You know, some women would really like that extra time, but increasingly we're seeing more people seek out concierge care or direct primary care because they want more time with their physician.
Speaker 1:And if you don't have that as an option in your area or you don't want to do that, that's fine. But you really have to be organized with your appointments and you may need more appointments or may need some of your care split up. Or maybe you'll see your physician for an initial assessment and then other parts of your care can be delegated to the nurse practitioner or physician assistant in the practice, and I've interviewed several of our APPs who were excellent and we talked about the role of those caregivers. So thank you so much for joining me in the Sunflower House, thanks for listening and if you haven't already subscribed, please do. Anywhere you listen to podcasts we're on Spotify and Apple and Podbean, amazon Music. Just support our podcast by hitting subscribe or follow and give us a five-star rating. And thanks again, and I'll see you next time in the Sunflower House, remember be strong, be healthy and be in charge.
