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Behind the Win - Women Who Win Unplugged
Doctor to Doctor: What Every Woman Should Know About Menopause
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In this episode of the Women Who Win health series, host Dr. Shikha S. Merchia, MD, speaks with OB-GYN Dr. Bailoo Rohatgi, MBBS, DGO, MD, FACOG, about navigating perimenopause and menopause with clarity and confidence.
With decades of experience—and personal insight—Dr. Rohatgi breaks down common symptoms, treatment options, and the critical role of lifestyle and emotional support. From hormone therapy to holistic care, this conversation empowers women to better understand their bodies and advocate for their health at every stage.
Hi everybody, I would like to welcome you on the behalf of Women Who Win here today for this interview, this health series interview that we're doing with Women Who Win. Let me introduce myself. My name is Dr. Shikamarchia. I'm a primary care physician. I'm double board certified in internal medicine and lifestyle medicine, and I practice here in Massachusetts. I'm a member of Iman, the Indian Medical Association in New England. I was their president last year, and I'm collaborating with Women Who Win to interview our guest today, Dr. Belu Rohatgi. Dr. Beluru Rohatgi is an OBGYN physician. She completed her MBBS, her DGO, and MD from India. She's been practicing since 1995 and moved to the United States in the year 2000. She then did her residency in OBGYN here. She is a fellow of the American College of OBGYN and has been practicing since she moved here. At home, she lives with her wonderful husband, her two loving daughters, and her handsome dog Bruno. And when she's not practicing, she loves to oil paint, write poetry, and perform dances on stage. So welcome, Dr. Rodgi. I'm so excited to have you. Thank you, Dr. Shekha.
SPEAKER_01Thank you for having me. So thank you for that beautiful introduction you gave it to everybody about me. I just want to let you guys know that I love what I do. I respect woman and I want to give her like a physical and emotional support because I believe, and I really believe, that woman is the most beautiful creation of Almighty God.
SPEAKER_00That's great. That's wonderful. Isn't that the truth? Let's dive right into our subject. It is a very hot topic, and everybody wants to know more about it about perimenopause and menopause. So, first question, Dr. Ruadgi, how do you define or how do you say what perimenopause and menopause is?
SPEAKER_01So they are two different things. Perimenopause and menopause are totally different things, and I can tell you exactly what happens because I've been a sufferer of both. So perimenopause is a phase which is called a transition phase in the life of a woman where she is still having symptoms which are similar to menopause, but she has not yet achieved menopause. Meaning few years prior to achieving menopause and a year after she has a final menstrual period is called perimenopause. And menopause is when a woman stops having a period for more than a year or more than 365 days.
SPEAKER_00Okay, so that's when. So when her period hasn't occurred for at least 365 days, we say she's in menopause. And just to clarify, I know there's a lot of confusion amongst women. So once you're in menopause, you're always in menopause. Is that correct? Yes, supposed to be like that. Okay. And so next question. So what symptoms do you see women come in most often with in during this phase of their life?
SPEAKER_01So talking about menopause, symptoms will be like hot flashes, night sweat, having vaginal dryness, moodiness, fogginess of the brain, joint pains. On the contrary, if it is perimenopause, where a woman has not yet achieved menopause, she can come with a history of or complain of irregular vaginal bleeding. She does not enjoy sexual life. Her desire for sex is markedly reduced. She is moody, she has anger outburst, and she is forgetful. She has issues with sleep. She's getting up many times in the night to have to avoid the urine and empty her bladder.
SPEAKER_00That's great. Let's break down these symptoms one by one. Do you order typically any tests for these women, or how do you approach them when they do come to you?
SPEAKER_01So if a woman is not yet menopausal, meaning she's still menstruating, but she's more than age 45 and having those symptoms which I just narrated, then I don't need to do the labs because the symptoms are speaking for itself. So I know that this is a change in the life. She might be just heading towards a menopause. However, if the same woman is between the age of 40 and 45, then I will definitely do labs which include like ovarian function tests, and main is the follicle stomach litting hormone, which is kind of a marker for menopause. Also, I would do the thyroid testing, progesterone level in her body, estrogen level in her body that is called estradiol, prolactin, and of course, if I need to do the vitamins levels and all to see vitamin D and all, I would do so. So that's a pretty complete workup. And you would typically do it in much younger women who you don't expect to be in perimenopause, is that correct? And if a woman is under the age of 40, then definitely I have to find out why she's having symptoms because under the age of 40, it is premature.
SPEAKER_00Okay. So then how do you approach now? So say you've determined if someone's just nearing menopause or they're in menopause, how do you approach the management of these patients?
SPEAKER_01Very good question, Dr. Shika. So it all depends on what is her primary complaint. They can be from anywhere from 40 to like total menopause a year after the last final menstrual period. So what symptoms brought them in? If a patient comes like this morning, I had a patient who came with the complaint of having decreased desire for sex. So that becomes her primary complaint. On the contrary, other people will or other women will come with the complaint of irregularity of bleeding. Somebody will have complaint of I'm skipping periods, or my periods are getting very heavy. So depend on what symptoms she comes with, I will address that.
SPEAKER_00Okay. So you address their condition based on what their concerns are. For example, if somebody came in with no periods and they're having hot flashes, do you consider hormone replacement therapy?
SPEAKER_01So depending on if her symptoms is prominently hot flashes and she is postmenopausal. Talking about the HRT, I have to first evaluate her. Is she the right candidate for HRT? We cannot just go and just treat her. So we have to evaluate her on the basis of her medical history, family history, her personal history, if she has any issues with irregular bleeding or she has postmenopausal bleeding. So those factors are very important. If the patient is still in the perimenopausal phase, she's still having her mancase, but they are irregular and they're heavy, then I will evaluate why she's having heavy bleeding. Can it be perimenopause or something else? So I will do like pelvic ultrasound, I will evaluate the uterus, and if suppose she needs to have biopsy, once I do the biopsy and the biopsy is negative, then I can manage her according to what I'm going to give her. Maybe it is pills, maybe it is something else like IUD. So according to the symptoms and the finding, I will treat her that way.
SPEAKER_00That's great. Thank you for that really comprehensive answer. That leads to our next question. What types of menopausal hormone therapy are available? What preparations can a woman take or choose from? Would you offer?
SPEAKER_01So let me clear it that hormone replacement therapy, and there is another thing, menstrual replacement therapy, and there is bioidentical replacement therapy. So HRT is basically for postmenopausal women. But if a woman is having her mances, that's when it be called menstrual hormonal therapy. And of course, bioidentical are the different products which you can use it for the symptoms. So let's take it like if it's a postmenopausal woman and she's having all those symptoms, as I said, I will evaluate her. And if she's the right candidate, then I will definitely give her estrogen. And if she has her uterus, then we can also combine the progesterone so as to protect the uterus. If a woman has no uterus, then there's no need of giving progesterone. We can only give estrogen.
SPEAKER_00That's great. And I think there's different oral and transdermal and other vaginal preparations.
SPEAKER_01Yeah, you can take orally, you can have a patch, you can use a gel, you can have pallets placed in the body, and then you can also use vaginal estrogen.
SPEAKER_00Wow, that's great. So that's a really good choice that they can choose from. And who are the candidates who cannot receive hormone therapy? Like, say you're not a great candidate or you're not a good candidate for hormones.
SPEAKER_01Excellent question. Those patients who cannot receive the hormonal therapy are number one, if they have medical issues like high blood pressure, they have uncontrolled diabetes, obesity, they have history of heart issues, they have high cholesterol, they have issues with clotting disorders, like they are very high risk for having deep vein thrombosis or pulmonary embolism. Or any woman who is having not well-defined bleeding, meaning if she is having irregular bleeding, which has not been evaluated. So I would first evaluate that and then give them medication.
SPEAKER_00Awesome. Thank you. And do you recommend any lifestyle changes for women with different symptoms? What lifestyle changes would you counsel them on?
SPEAKER_01That is another good question because those women who are not the good candidate for the medication, they definitely need to work on their activity of daily living. For example, if they are too much into coffee or tea, hot beverages, they should avoid all those beverages, hot beverages. I would not say they should stop it, but they should reduce the amount because these kind of beverages are the trigger of the symptom. They can lead to the symptoms. Secondly, they should do exercise because when you hit menopause, every part of the body from top to bottom is affected, from your brain to your skin, to your breast, to your vinyl area, to your bones and your legs. We have to make sure that they do some kind of exercise every day so as to make their bones strong and their muscles strong so that they can prevent themselves from having osteoporosis. They should include vitamin D in their daily routine and then calcium. Calcium not too much, but vitamin D definitely, weight-bearing exercise, they have to do it. Swimming is good, biking is good, walking is good. Great. Then if they want to have some other kind of options, they can take soy product like soy milk, soy seeds, they can have tofu, they can have ed mame, they can have almond milk. These are all natural plant-based estrogen producing, making like food stuff.
SPEAKER_00That's great, thank you. So lots of lifestyle changes can help women during this. And so that brings us to some other symptoms. Due to mentioned about bone health. So, you know, women do this accelerated decline of bone health, and you said weight-bearing exercise, calcium, and vitamin D. Uh, what typically for vaginal dryness do you recommend?
SPEAKER_01So, vaginal dryness is very, very common, and that leads to frustration in the woman because now they cannot have very pleasurable sexual life, and that is sometimes the woman comes with. So, for that, we can use vaginal estrogen. However, if she's not the right candidate for even vaginal estrogen, there are over-the-counter many products which are helpful for vaginal lubrication. For example, they are water-based jellies like KY jelly, they are oil-based like vaginal lubricants, like riplants. Recently, there are other medications which have come in the market like capsules. They are supposed to be which are combination of collagen, halourinic acid, and almond oil. So they actually made the vaginal mucosa very healthy and it started producing some kind of lubrication, which helps them in their sexual life. That's great.
SPEAKER_00And then I think I hear a lot of women also complain about like brain fog, etc. So, what would you recommend for that? Like this, I feel so tired, I don't sleep well. Insomnia is a big one during perimenopause, menopause.
SPEAKER_01So, those are another key symptoms of having the fun of being menopausal. So, if they are only having problems with sleeping issues, they cannot sleep very well, then they can take over-the-counter some kind of like sleeping medication, like unisom. However, if they are getting fogginess and they cannot focus, and that is leading to frustration and moodiness, and they are not having control on their activity and all, and they are not a good candidate for hormones, then there are medications like Zoloft. Zoloft was previously made for depression, but it is found that if you take Zoloft in a smaller doses, then it can take care of your heart flashes, it can make your fogginess go away, you feel more under control, and your decision making can be improved.
SPEAKER_00That's great. That's a good tip to know about that you can ask for medication like Zoloft. And then uh the other thing I think I see a lot of patients, and I want to ask you about is they gain weight around their abdomen, they really are upset about it. So, why do you think that happens and what can they do about it?
SPEAKER_01When a woman is in a menstrual phase of the life, there are two important hormones, estrogen and progesterone, which are secreted by the ovary. Woman remains under the influence of this hormones throughout the life, but when she hits menopause, these two hormones they actually come down totally to like bottom out. But there's another hormone called testosterone, it is also secreted by the ovaries, and that hormone becomes prominent after achieving menopause. So, testosterone being the main hormone now, it will give all the symptoms of men because it is the mainly the men hormone. So, woman will encounter having thinning of hair, baldness, she can have some kind of hair growth around her chin. Like you can see, your great-grandmother they have mustaches, then she can have trunchal obesity. Now, other thing is in the deficiency of estrogen hormone, the woman actually loses the height because the bones are now becoming weak. So bones try to like collapse or osteoporosis can happen. So by losing the height, the abdomen becomes more prominent because it's squished out. So, of course, because of the testosterone and then deficiency of the height which she was having before. Now she's not as the tall as she was before.
SPEAKER_00Wow, that's uh a lot of changes for them to contend with. So, what do you counsel them on the abdominal obesity? So we know that testosterone is increased, their height's decreasing. What could we do to help it?
SPEAKER_01So, being vigilant about these things, first of all, I always tell my patient don't feel bad about it. Just tell yourself and reiterate yourself, it is not your mistake, it is the hormonal change, which is one phase of life. So we have to be very careful. Do your regular exercise, make sure you are avoiding too much of like cheese, soda, like all the junk food. Because at this age, it's very difficult to get rid of weight, so you have to be very vigilant. Take vitamin D so as to support your bone, do weight-bearing exercise to strengthen your muscles and your bones?
SPEAKER_00That's great, and then I know lastly, this leads into the same thing, and I think the answer may be tied in. The number one killer of women is also heart disease, and their heart health can be affected, and I think it gets more affected in perimenopause. So, how do you deal with that? How do you counsel your patients on that?
SPEAKER_01That is again one of the things which we have to be very careful about because once a woman achieves a menopause, her lipid profile worsens, so and she tends to be like a high like risk for having heart disease. Because as long as she's not menopausal, her own natural estrogen and progesterone protect her heart, but after menopause, she's not having any estrogen from her own body, so she is at risk of heart attack. If you see a woman of the same age as man after her menopause has a higher risk of heart attack compared to the man of the same age. So having a baby aspirin daily protects, making sure your lipid profile is within normal limit, and you do all the efforts to protect your heart.
SPEAKER_00So, same thing, the lifestyle changes, of course, then you probably refer out to primary care physicians as well. Absolutely.
SPEAKER_01So, if her lipid profile is off, then definitely she should see her primary care. They can include some cholesterol medication, they can start the baby aspirin, but all the women should be aware of that, that they have to take care of their heart.
SPEAKER_00Awesome. Thank you so much, Dr. Ruhatki. My last question is where can patients find you if they want to see you? This wonderful interview that you did, but they want to become your patient. So, how can they find you?
SPEAKER_01So I'm currently working in Milford, and my address is 200 Commerce Drive or Northbridge. They can always come to my office. I'm happy to see them with any questions, any concerns. If they cannot come physically, I'm happy to do telemedicine with them and I'm ready to help them.
SPEAKER_00Thank you so much. It was wonderful having you. Hopefully, we'll be able to do another interview on another topic soon.