Ep 40: When Menopause Sends You to the ER with Dr. Jessica Yearwood

In this episode of 'Reset Recharge,' host Dr. Komal Patil-Sisodia, a triple board certified endocrinologist, interviews Dr. Jessica Yearwood, a Menopause Society certified practitioner, about the deep impacts of perimenopause and menopause on women's health. The conversation covers a range of topics including cardiovascular health, urinary tract infections, osteoporosis, vasomotor symptoms, and abnormal bleeding. Dr. Yearwood shares her insights and experiences as an emergency medical physician and provides valuable advice on managing these conditions. The episode emphasizes the importance of self-advocacy and informed discussions with healthcare providers, aiming to empower women to take control of their health during the menopause transition. Dr. Yearwood also introduces her new menopause clinic in Gig Harbor, Washington, which offers consultative and direct care for women.

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Audio Stamps:

00:00 Introduction to Reset Recharge

00:55 Meet Dr. Jessica Yearwood

02:07 Understanding Menopause Symptoms

05:12 Cardiovascular Health and Menopause

16:30 Genitourinary Health and UTIs

25:21 Musculoskeletal Health and Osteoporosis

32:39 Vasomotor and Neuropsychiatric Symptoms

37:28 Abnormal Bleeding and Menopause

43:56 Dr. Yearwood's New Menopause Clinic

46:39 Conclusion and Contact Information

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:02

Welcome to Reset Recharge, the podcast where women's health takes center stage. I'm your host, Dr. Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert. This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider. Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place. As a physician, my goal is to educate on this podcast. The content shared here is for informational purposes only and should not replace personalized medical advice. If something we discuss resonates with you, please talk to your healthcare provider at your next visit. Now let's dive in and help you reset, recharge, and take control of your health. Welcome back to another episode of Reset Recharge. I'm your host, Dr. Komal Patil-Sisodia, and I'm excited to introduce our guest this week, Dr. Jessica Yearwood. Jessica and I, first met at a. Conference for female physicians called Brave Enough in 2021. We met through a mutual physician friend, and I was so excited when she reached out to me, to let me know that she was delving into menopause care and is now a Menopause Society certified practitioner. A little bit of background on Jessica. She grew up in Puyallup in Washington state. Went to undergrad at the University of Puget Sound and Medical School at Medical College of Wisconsin. She graduated in 2006 and did her residency training in emergency medicine at Yale, where she also worked as a clinical instructor for a few years before moving back

Dr. Jessica Yearwood 1:41

to Washington State for, community practice.

Dr. Komal Patil-Sisodia 1:44

There's no place like home. Every friend of mine that's in our age range that left the state, came back with their families. I grew up here as well, so yeah, everybody's back from Washington. It hard to stay away. Yeah, it is. It's like a hidden gem that most people dunno about, but here we are broadcasting it to everyone who's listening. I was really excited to interview you today, Jessica. Welcome to the show. I'm so excited to have you here because you have such a unique perspective on menopause I'd love to hear from your words what led you to this type of care and inspired you to take this path.

Dr. Jessica Yearwood 2:21

Thanks for having me, and I'm excited that we did get a chance to reconnect here, and learn, from your experience in menopause care. I got interested, driven by my own health symptoms and, answers that I wasn't getting from the physicians that I was seeing. And so I ended up, finding and joining the Menopause Society initially to get access to the clinician based education that they had. I needed to educate myself. Then I looked into more specific, hormone prescribing courses the more I, learned, motivated by trying to figure out what was going on with me, I started to notice a lot of similarities in what was going on with patients that I was currently seeing and then looking back, had seen over the years, in my emergency medicine practice.

Dr. Komal Patil-Sisodia 3:09

Yeah. And a lot of times women will go into their primary care doctor's office or seek out regular care and they're not necessarily getting answers to their symptoms, right? So they keep thinking that, oh, my labs are normal. There's nothing really that they're finding. And then it scares people to a level of if they can't figure out, maybe it's something more dangerous and maybe I need to end up in the emergency room. Is that what you're seeing?

Dr. Jessica Yearwood 3:35

Yeah, absolutely. I think there's such, an overlap between, some very serious health conditions and symptoms that are brought on by the hormonal changes of perimenopause and menopause. If you're patient and you've had some kind of minor symptoms or ongoing symptoms, that you don't have answers to or suddenly have really significant symptoms out of the blue, and you're very scared and you need to go get some answers. I think it is important to say too that, the symptoms of perimenopause and menopause are a diagnosis of exclusion. There's not a test that's gonna say, this is absolutely perimenopause, or this is menopause. We need to do some testing at times to figure out what isn't going on, before we move on and say, okay, I think that we can attribute this to some hormonal changes and, start some treatment and see if that helps.

Dr. Komal Patil-Sisodia 4:31

I think that's great perspective, because some of the symptoms of menopause can be the symptoms that present in life-threatening conditions, right? Absolutely. If you are not sure which one is which, it's best to do your due diligence, but then if all of that is ruled out, we have to look to other things. I would love to, chat with you. Go through just the top things that you are seeing when women come into the er, which menopausal symptoms you see creating the most number of women coming through, and how you can tell if something is hormone related versus not, and something more dangerous. I'd love to work through that with you, and jump into each of the different organ systems. Let's start with cardiovascular. This one is near and dear to my heart because of everything my mom went through at such a young age, being diagnosed with heart disease in her forties after having a hysterectomy earlier on. We know that menopause when, not treated, especially in younger women, will lead to increased risk of cardiovascular disease. We know that cardiovascular disease presents differently in women compared to men. I'd love to hear if you could give us a snapshot of the average woman who comes in and what that looks like.

Dr. Jessica Yearwood 5:42

One of the biggest, symptoms is gonna be palpitations. Palpitations basically is when you experience an abnormal heartbeat and that can be variable for a lot of different people. You could feel like your heart is racing. You could feel like your heart is skipping a beat or catching. It could, be a couple of beats or it could last for seconds or minutes or sometimes even hours. And, some other accompanying symptoms that might occur is dizziness or lightheadedness with it, or even a feeling of, difficulty breathing or you can't catch your breath or even chest pain palpitations, are a vasomotor symptom, of perimenopause and menopause, but there's also other underlying diagnosis that are more serious, and medical conditions that need to be evaluated when someone is having palpitations. When people come in and, are evaluated in the emergency department for those symptoms of palpitations, one of the first things we do is get a, electrocardiogram, or you may have heard that, called an ECG or an EKG. And that's looking at the electrical conduction system of the heart. There's a very normal pattern that we see when we look at the EKG, that tells us that the electricity, which drives how the muscle squeezes and moves the blood, through the heart and into the body. When someone's having palpitations, we certainly look for abnormal electrical, patterns that might be an underlying cause of those palpitations. Palpitations can be benign. We all get extra beats, premature atrial contractions or premature ventricle contractions. Everybody experiences or feels those differently, but when they happen frequently, they can be really, bothersome. One of the things to point out is when we're getting that ECG if you aren't having symptoms at that time, we may miss, what was causing those symptoms. We don't necessarily, stop there. We'll check some blood work. Getting a complete blood count, making sure that someone isn't anemic or having a low red blood cell count, which can drive some symptoms of palpitations, as well as those other symptoms of chest pain or shortness of breath, dizziness, lightheadedness, even passing out. We usually check a complete metabolic panel, which is your electrolytes, so your potassium, calcium, magnesium. Even sodium are all very important in how the electricity, runs through your entire body. Sometimes, checking some heart enzyme tests to see if there was any damage to the heart muscle. We may be, checking, and sending thyroid tests.

Dr. Komal Patil-Sisodia 8:04

Are up in my office.

Dr. Jessica Yearwood 8:05

Near and dear to your heart. It depends. Sometimes we won't get those thyroid tests back, in the emergency department. There's other symptoms that we're looking for that may go along with, really high thyroid, function or really low thyroid function, that we might ask the lab to run those tests, faster.

Dr. Komal Patil-Sisodia 8:21

What I'd love to hear is when people are having these symptoms, what are the major things that you are looking for that are life threatening? Let's talk about those first and then how the symptoms of those are different than what you may experience in menopause. Because there are always subtleties but when I am self diagnosing online and looking at stuff that's not in my specialty, I think this is a universal experience for anybody who's worried about something that's going on in their body, whether they're a medical professional or not. Just reading a list of symptoms can convince you that you have something. But when we come in to see an expert like you it would be great to hear your perspective on what the serious conditions are, and how we can differentiate.

Dr. Jessica Yearwood 9:04

Yeah, absolutely. So those serious conditions are arrhythmias. We're looking for atrial fibrillation, we're looking for the supra ventricular tachycardias. We're looking for ventricular tachycardias. The things that are driving your heart to beat much faster, than normal, causing that feeling of racing heart, and other symptoms. If you are actively having symptoms and we see one of those conditions is going on, then we're gonna, treat it in the way that we need to. If you are having symptoms and none of those things are going on, we're immediately reassured that your symptoms are not tied to those, dangerous, arrhythmias, it doesn't mean that other things might not be going on, but, usually if you are experiencing symptoms and we have you hooked up to the EKG monitor or the telemetry monitor and we're not seeing any abnormal electrical activity, that's definitely reassuring that maybe something else is going on. things that are going to differentiate, more of those dangerous things from. menopausal and hormonal related things are symptoms that are not necessarily, sustained. Symptoms that come and go that are more, brief in nature, symptoms that are not necessarily, associated with other things like significant chest pain or, ongoing difficulty breathing, having symptoms when you don't have a lot of other medical risk factors for the big, bad, scary things. So I would be more concerned if someone's having symptoms, if they have underlying known cardiovascular disease, if they have underlying, diabetes or high blood pressure, strong family history of, some of these other, dangerous conditions. I think those are some things that will differentiate, dangerous and not dangerous.

Dr. Komal Patil-Sisodia 10:50

How many do you estimate actually end up having something that is life threatening versus what would you estimate the percentage of women who are coming in with significant menopause symptom?

Dr. Jessica Yearwood 11:00

That percentage is gonna shift and change, probably as, the younger, women, probably less likely to be having some of those dangerous things. Percentage probably increases as we, get older and make it into those sixth, seventh, eighth decades of life. But I would say overall the, majority of patients that come in, do not have something more serious going on or have more benign conditions like premature atrial contractions or premature ventricular contractions. The majority, are not being admitted to the hospital or given a specific, diagnosis. When they're discharged.

Dr. Komal Patil-Sisodia 11:37

Can you talk a little bit about how estrogen loss may lead to some cardiovascular changes or, contribute to what these patients are feeling?

Dr. Jessica Yearwood 11:47

As you've talked about before on your podcast, we transition, through perimenopause and menopause and estrogen goes down, those cardiovascular risk factors that estrogen has actually been protected for. So elevated blood pressure, lipid profiles, development of atherosclerotic disease, are unmasked, and, increased as we lose estrogen. as, patients are getting older, or getting beyond, those. Years of their final menstrual period, into the post menopause state, our suspicion for more of those serious things, needs to be higher. And, we need to be aware of that.

Dr. Komal Patil-Sisodia 12:23

we talked about that.

Dr. Jessica Yearwood 12:25

Do you want me to say something about, if you end up, in a situation where you're concerned about going in or not, erroring on the side of caution, and then maybe, being aware because maybe your physician is not aware to tell you about things to follow up, or you may need some outpatient testing

Dr. Komal Patil-Sisodia 12:40

can you talk a little bit about what takeaways you want women who are leaving the emergency room with cardiac symptoms and a negative workup for something dangerous, which is great news, but how can they follow up as an outpatient and get the help they need?

Dr. Jessica Yearwood 12:55

Yeah, that's a great question. You certainly need to be, your own biggest, advocate. The information, that emergency medicine doctors have about the impact of perimenopause and menopause, on these presenting symptoms is definitely variable. Just because the testing we can do. When you come to the emergency department is negative or hasn't given us a specific diagnosis. It doesn't mean your symptoms aren't real. It doesn't mean what you're experiencing isn't valid. It doesn't mean there isn't other testing that might need to be done. in the case of palpitations, a lot of people may warrant extended monitoring. Referral for something like a Holter monitor or patch that will monitor over days or even weeks to see if there is something underlying that didn't show up in the emergency department. Some people may need additional testing, like an echocardiogram, or ultrasound of their heart to make sure everything structurally looks, fine. They may need to talk to their doctor about. How this plays in with potentially other perimenopause or menopausal symptoms that they're having and talk about, if they are a good candidate for a trial of hormone therapy to see if that helps the symptoms, while maybe they're getting additional testing done. I attended the Annual Menopause Society meeting recently and there was, a lot of discussion about, chest pain in, this age group, of women and, really how cardiovascular, risk is underestimated, in women in general. there are some different, pathophysiology or, the way things happen in the body in women, with regards to cardiovascular disease that may not necessarily show up. On the traditional ways that we test or look for those things in the emergency department. So people may be coming in with chest pain and, we may not see the big changes that we look for a big heart attack on the EKG. Or we may not see changes on the lab testing that we, check, something called a troponin, which looks for heart muscle damage, when blood flow has been cut off to the heart muscle in a heart attack. If you walk away without specific answers, try not to feel disappointed, advocating for yourself, following up and knowing that, there could be a role for hormone therapy to help with some of these symptoms.

Dr. Komal Patil-Sisodia 15:11

That's great advice you wanna hear Something interesting I learned this last week is that biotin can make troponins be falsely negative. How many women do you know are on biotin for hair, skin, and nails? If it's a radio immunoassay that's being used for the troponins, they can sometimes be falsely negative in women. I had no idea until last week, I always tell everybody about biotin for their thyroid function test because it will mess with those. It doesn't actually cause an issue. But in the cardiovascular space, it was so scary to think that something so benign that we tell people to take for their hair, skin and nail can have such a profound impact. I can't even imagine, being on the receiving end of that and have that missed.

Dr. Jessica Yearwood 15:52

For the listeners if they are on biotin supplements and they do end up in the emergency department with, chest pain symptoms and a troponin is being done. To ask if it's a, biotin, sensitive, assay. I'm gonna have to go back to our lab and ask that question.

Dr. Komal Patil-Sisodia 16:08

I was gonna do the same thing at our hospital because I oversee some of the medical specialties clinics, not cardiology, but it was something that popped up in my head and there's so many women in my clinic, who are convinced that it's their thyroid or something else that's causing their hair loss, and so they're trying to grow it back with biotin. All these things we learn when we finally all get a chance to talk to each other and compare expertise. Let's move on to the genital urinary, system. UTI is a big, issue in women, especially as they start to get later in perimenopause and into post menopause. I'd love to hear from you, like what are the things that you're seeing coming into the ER and what is your approach to dealing with it, depending on the age of your patient?

Dr. Jessica Yearwood 16:52

Yeah. I think UTIs, and, vaginal symptoms, itching, discharge, are really, big complaints that end up bringing people into the emergency department. Especially, two or three in the morning when the symptoms start, you can't sleep and it's really inconvenient and it's a Friday night and, everything else is gonna be closed over the weekend. This is huge. The declining levels of estrogen, in perimenopause and menopause. Affect the genital urinary system and tracted, immensely. There's architectural changes to the tissues, that, overall, I guess reduce the health of these tissues. Reduce their ability to, of the immune function, system, the gatekeeping system that keeps everything, from getting, infections, all of the bacteria in the gastrointestinal tracts, that live on the skin, around the vulva and the perineum, around the rectum. Those are the typical, bacteria or pathogens or bugs that cause urinary tract infection. As the tissue starts to change from that loss of estrogen. The normal function of preventing those infections, decreases. There's increased risk of having those infections and recurrent infections, those can present, burning urgency, frequency, blood in your urine, lower abdominal pain or pelvic pain. If you've ever had one, it's pretty uncomfortable. Typically antibiotics are the mainstay treatment of a, true urinary tract infection. What we're doing to test for that is getting a urinalysis, which is looking for, really secondary signs of infection. So inflammatory or white blood cells within the urine, blood, the presence of bacteria. Some other, chemical reactions that may be positive, like leukocyte esterase presence or nitrite presence. And, we're treating based on symptoms and that urinalysis. The gold standard of, urinary tract infection is getting that urine culture. So seeing what bacteria actually grows out of the urine and what antibiotics, those bacteria are sensitive to. Those tests often take one or two, sometimes more, days to result. So we're often just treating on, symptoms or the results of the urinalysis. Those presenting symptoms can be very mild, to very, serious and complications of upper urinary tract infections, which is pyelonephritis or kidney infections. Yeah. And even systemic or whole body response to infection, which we call sepsis. If you are younger and healthier without a lot of underlying medical conditions, the likelihood that you'll have an uncomplicated urinary tract infection or UTI High, as you age, and have other medical conditions especially, if you are, elderly and, in a nursing home type of environment or, not able to really care for yourself. Very much higher risk of having those more complicated and serious infections.

Dr. Komal Patil-Sisodia 19:47

Yeah. I worked as a hospitalist for a bit and the number of older women who came in with u sepsis. It can be life threatening and have a very high mortality for these women. What tends to be your approach once you get all of these tests? What does your conversation generally look like, with patients around this issue?

Dr. Jessica Yearwood 20:07

several years ago I started, asking more questions, not just about the urinary tract infection, but if there was other underlying symptoms that they were experiencing. Are they having, vaginal dryness? Are they having, uncomfortable or painful, sexual activity? Are there other things pointing towards a broader, genital urinary syndrome of menopause having conversations about, why these urinary tract infections are occurring, asking them, are they happening after sexual activity? Are they, happening after, they have been sitting for long periods without emptying their bladder or when they have decreased, fluid intake, asking about incontinence and if they're wearing any, products for incontinence. Because, if you have, urine soaked incontinence products, sitting next to the, vulva and vagina where the urethra, opening is, you definitely are gonna have higher risk for having that bacteria be able to get up into the urethra, into the bladder and start to cause a problem. If they were answering yes to a lot of these questions, I was asking about, low dose topical vaginal estrogen use, and if anyone had ever spoken to them about that or did they know that might be beneficial? I found that, I was often the first person who had that conversation with them when I was seeing them for the first time at, two or three in the morning with symptoms. I started, talking to them and counseling initially about, Hey, maybe you want to talk to your doctor about this. And then I, had a turn in practice and I thought to myself, why am I not just prescribing this? They are in front of me right now. I know that it's going to be weeks or months before they get a primary care appointment. To follow up on this. And I just knew that it was so important. Now the guidelines have changed where this is first line treatment I think if you see something and you are asking the right questions and you know what the answer is to treat it, you really should ethically be having those conversations and prescribing the medication at the time you're seeing those patients.

Dr. Komal Patil-Sisodia 22:09

I totally agree. It's been lovely to see such a change in practice around this. A lot of women were afraid to use vaginal estrogen'cause of what was written on the black box morning. And we've had a great group of physicians go out there and advocate have that removed from the labeling of hormone products, I think that's good. My hope is that we see more women, utilizing this therapy because sepsis is such a preventable death in older women. And if we can do better by them from this regard, I think that's excellent. So thank you for sharing your experience

Dr. Jessica Yearwood 22:42

for, listeners, if you are someone who has been experiencing. Recurrent urinary tract infections. If you are having symptoms of vaginal dryness, painful, sexual activity. If you end up in the emergency department at two or three in the morning, ask about, vaginal, estrogen. Again, the, probably experience in education of our emergency medicine, providers is, might be a bit limited. But I think you do have to advocate yourself and I think that this is information that, should be getting to emergency medicine. Providers, several places are updating, their care guidelines to include, low dose topical vaginal estrogen as a treatment, with, recurrent urinary tract infections. the exposure to antibiotics, even if it's only a three day treatment, for an uncomplicated urinary tract infection, has potential for, cumulative, changes. It can disrupt your gut microbiome. It can put you right at increased risk for developing gastrointestinal related infections like Clostridium difficile, which is a horrible diarrheal illness. It's very difficult to treat. Also, development of resistant bacteria, may make it more difficult to treat other infections. In my practice I see people coming in who need, several days of iv, antibiotics to treat simple, urinary tract infections because the oral options, the pills that we have to treat them don't work anymore.

Dr. Komal Patil-Sisodia 24:04

Yeah.

Dr. Jessica Yearwood 24:05

These women are in their fifties, they're in their sixties. I find myself the first person having the conversation about, vaginal estrogen and treating the underlying problem. This is definitely a big deal. Emergency medicine providers, can have a really big impact.

Dr. Komal Patil-Sisodia 24:19

That's fantastic. You should go teach that honestly, because it will save a lot of lives. So that's my 2 cents.

Dr. Jessica Yearwood 24:26

I should do that because I emailed, cME when I got done with the Menopause Society, I, was looking at, the history. There's 15 years of CME stuff on there. There was nothing on menopause and perimenopause. I emailed and they wrote me back and they're planning something for January or February. I'm like, this needs to get out there. I would love to do that. You should do it. It really is not scary. It doesn't take a lot of time. And especially now with the black box warning, gone, there's no reason not to. Exactly.

Dr. Komal Patil-Sisodia 24:53

Thank you so much for that great explanation hopefully, to all our listeners out there, you're hearing loud and clear what Dr. Yearwood is saying about making sure that you are talking to your doctor, especially if you're having these recurrent infections. If you're lucky enough to run into somebody like Dr. Yearwood who is going to prescribe that for you, all the better. My hope is that, we're able to impact enough, er healthcare providers to start doing this without fear of, the hormones potentially causing further issues. Let's move on to the musculoskeletal system. One of the most common complaints I see coming into my office is joint pain, stiffness, frozen shoulder, and then as an endocrinologist, because I do a lot of osteoporosis, fractures. So I'd love to talk through each of those with you, hear what your recommendations are, and then let's chat through that.

Dr. Jessica Yearwood 25:43

I think, starting with fractures, that's a big one. That's bread and butter, emergency medicine, daily, complaint, hip fractures, wrist fractures, are huge. They're a complication of, osteopenia and osteoporosis, which is driven by the loss of estrogen. We reach our peak bone mass in, early thirties, and then start to have decline, and, really accelerated decline during that menopause, transition those few years around, the final menstrual period we're looking at, those fragility fractures, the ones that happen with lower impact, injuries. And, I think, there's prob whole different conversation about ma managing osteoporosis and osteopenia. The takeaway, is that these are potentially preventable. The problem is that we're often starting too late and identifying people at risk. And we're often starting too late, in treatment, or not initiating treatment once someone has one of these first, fragility fractures.

Dr. Komal Patil-Sisodia 26:44

There's so much distrust of the medications that came out for osteoporosis treatment, like alendronate, all of these bisphosphonates and things like that. When they first came out, people were starting them early and they weren't understanding that they shouldn't use them for more than five years in a row. People were getting atypical fractures. By the time a woman shows up in the ER with a fragility fracture, it's too late. The studies for hormone therapy and menopause are so interesting because they gave women hormones for five years, saw a 20 to 40% reduction in fractures. But when they took the hormones away, all of that effect went away. So it was never approved for the treatment of osteoporosis only to prevent progression from osteopenia, which is weakening bone, to osteoporosis, where you're at higher risk for fracture. I'm sure you see that a lot now in the er. When you are getting imaging, for these patients with hip fractures are you seeing changes on the x-ray that indicate they may have thinning of their bones?

Dr. Jessica Yearwood 27:43

A lot of the times the radiologists who are reading the fractures will comment, on, whether the bones look osteopenic or osteoporotic. But the education we get in emergency medicine isn't really guiding us, to call that out to patients. For people who are listening, the recommended age for DEXA screening is 65, maybe a little bit earlier if you have other risk factors. If you are under that age and have had, a significant fracture, wrist, hip, ankle, ask and make sure you are getting appropriate follow up, to identify, your bone density and where it's at so that you can start, intervening if osteopenia or osteoporosis is present, and, start, making those changes. If you haven't had a fracture, being aware with the loss of estrogen you gotta start early. Make sure your nutrition is, dialed in your vitamin D and calcium intake is appropriate and you're doing strength training or jump training to, maintain that bone, density. Even trying to build it if, you are a little bit behind, or have lower bone density, realizing who's at risk. If you are a thin person, under 127 pounds, is a risk factor, for, osteoporosis. If you, have Asian heritage, also another, risk factor. And then there's a lot of, metabolic, conditions and medical diagnoses or even medications that put you at risk. Steroids. Exactly. So just knowing that and, having the conversation with your, doctor, if they're not bringing it up, please feel empowered to ask questions.

Dr. Komal Patil-Sisodia 29:16

As an endocrinologist, I know the US Preventative Services Task Force and the American College of Gynecology, say 65 and older, the Endocrine Society advocates for 50 and older if you have risk factors one of the things that I do is I will do it if there is early menopause in women. All that time that passes that they're not getting evaluated, is important. The American Diabetes Association put in their standards of care for people who have had diabetes for longer than 10 years. They're at increased risk of fracture. And what they found in their studies, and this was the other thing that just you're actually at increased risk for fracture, both with diabetes and without. I kept thinking, how many years have I cast that off and not really thought about it, this was some newer data that came out. There are some newer things that we're learning for all of our listeners that are mind blowing.

Dr. Jessica Yearwood 30:07

Yeah, exactly. And then thinking about, people, that have other underlying medical conditions or obesity, if they do sustain a fracture it does require surgical repair, which, most hip and femur fractures, do, they are at increased risk for, complications, delayed wound healing, more difficult postoperative, courses as well. we know that even without increased, risk those who sustain hip fractures are at increased risk of dying, within the first year after that fracture. Increased risk for not returning to baseline functioning. Maybe not even getting out of the nursing home, this is something that's near and dear to me. I watched, my grandmother, go through two hip fractures, within a few years. To see the acceleration of her cognitive and functional decline, after those, injuries and, surgeries massive witness. Transitioning back to the urinary tract infections. She, ended up in the, emergency department and hospitalized for recurrent urinary tract infections, in conjunction with some complications. In her eighties when these things were happening, but, I've seen this happen to women who have been much younger, really does have a huge impact on, potential for quality of life quantity of life, once you have a major fracture.

Dr. Komal Patil-Sisodia 31:27

I would agree. It's such a common story, and I'm glad you brought up the connection to the UTIs, if the TI gets bad enough and somebody gets dehydrated and dizzy, they're gonna be at a higher risk for a fall and a fracture. Exactly. And a lot of times we see the two coming in together and that is a high risk scenario for anybody dealing with both that's a great point. I'm sorry to hear about your grandma. It's always hard when it's the people we love that we're watching go through all of this.

Dr. Jessica Yearwood 31:54

I think it also gives you perspective about what your patients are going through and what they've gone through. And, an ability to provide, guidance on maybe what to expect and questions to ask along the way. I feel like some of these things, that have happened in my personal life have made me even more, adamant about being able to tell people and empower them, with these conditions.

Dr. Komal Patil-Sisodia 32:18

Yeah. I have such empathy for our mothers and the generations that didn't get the option of hormone therapy. I think about this all the time, is how different would their quality have life been had they been given these options? So no. And I don't think we'll ever have that answer, but, we can do better by all of the women in the subsequent generations. Let's, switch gears to, vasomotor symptoms, anxiety and neuropsychiatric symptoms of menopause. You must see quite a bit of that because those symptoms can be mistaken for other things. I'd love to hear your experience with that

Dr. Jessica Yearwood 32:54

hot flashes and hot flushes, I am 46, I am perimenopausal. I, have some occasional warmth and, feeling, that I'm experiencing. I haven't personally experienced, a major hot flash or hot flush yet. From descriptions and what people have shared, the first time it happens, it can be pretty, scary and pretty uncomfortable to all of a sudden start feeling hot and sweaty, and actually having physical perspiration, which may or may not be associated with palpitations. If your, sympathetic nervous system gets revved up and you start to feel anxious, have breathing trouble. You could think something serious is going on. You could be concerned about a heart attack, or, some other major medical issue that could land you in the emergency department. Maybe you would feel, different if you're sitting in the waiting room and go, oh my gosh why am I here? Maybe the experience isn't great when you come in tell your story get some tests done and everything's fine. And, the person who's seeing you maybe doesn't recognize that was a hot flash and doesn't give you that. Possibility or education. You might walk away going, maybe I shouldn't have come in. Or, what's wrong with me? Something felt really bad and they said everything is fine, and then maybe it happens again. And you're thinking, do I go back to the emergency department again? They told me everything's fine, but everything doesn't feel fine. Recognizing that is a symptom that can, occur for a lot of people. It's hard to say, don't go to the emergency department or don't be evaluated when you have new symptoms. I think you absolutely should. But for the people who are listening, if that's happening, be mindful of that, and you might have to bring it up as a possibility that this was a hot flash.

Dr. Komal Patil-Sisodia 34:38

I think that's a great point. If this is a pattern you're going in, every time you're feeling terrible and nobody's able to give you answers talking to your primary or somebody who is a menopause aware healthcare provider is probably going to get you the most bang for your buck. I haven't had a hot flash yet in perimenopause, but I remember after giving birth to my son, we were living on the east coast at the time, and it was 18 degrees in Baltimore the pregnancy hormones just make you feel so hot, I rolled into the hospital in a sweater, didn't have a coat gave birth, went home a few days later and the hot flashes that came postpartum. Oh my gosh, right? It's a low

Dr. Jessica Yearwood 35:17

estrogen state.

Dr. Komal Patil-Sisodia 35:18

It is. And I had such empathy for my menopausal patients, it was so bad that I had. The windows open and the fan on, and it was 18 degrees. My husband was like, I'm taking our kid and going to the other room'cause we're both gonna die in here but it was impactful. I think people underestimate how severe it can be for some women. Some women are, lucky and barely feel anything and move on. But there are some who really have those persistent hot flashes. Another pattern I see in my practice is that women will go through menopause, have their hot flashes, everything will calm down. Then 10 years later, they come back in their seventies or eighties and I'm ruling them out for adrenaline producing tumors. It generally has always come back negative with the exception of one patient in the last 16 years. To me that sounds miserable. I can't imagine being in my seventies or eighties and having hot flashes.

Dr. Jessica Yearwood 36:14

I think you make a really good point. If you are post-menopausal and you start having symptoms again, it is very important to exclude new diagnoses. A hot, flush and sweating associated with nausea with or without chest discomfort or difficulty breathing, could represent a cardiovascular event or a myocardial infarction. We know that presents differently in women I can't tell you the number of times I have, looked at an EKG, handed to me from, the waiting room. Someone has come in with nausea and sweating. And it's an actual heart attack. You need to get the person, in front of the cardiologist in the cath lab to open up a blocked vessel. The majority of those are, women, patients. That's so interesting. So are those types of heart attacks, those inferior myocardial infarctions, present. Not necessarily with a lot of chest pain, but more of autonomic symptoms. So the sweating, the nausea, the low blood pressure, maybe some epigastric discomfort. When you are having new symptoms, that have come up after being symptom free for a long time, you need to make sure that nothing else is going on. Something new, thyroid or something, metabolic, is happening.

Dr. Komal Patil-Sisodia 37:24

Yeah. Let's move on to the reproductive and gynecologic system. I am sure that you see a lot of women coming in with, issues in this particular arena, like bleeding after they've already gone through menopause or heavy or prolonged bleeding during perimenopause. So can you talk a little bit about that?

Dr. Jessica Yearwood 37:43

Yeah. Abnormal bleeding, is a really common thing that brings, women into the emergency department. I think it's one of those things that, probably gets pushed off as not being super serious, because everyone's okay, it's menstrual period. What do you want us to do about it? I think, is the attitude that a lot of people have. But I think you have to approach this, as a clinician, really thoughtfully and, ensuring that nothing serious is going on. We know that during the menopause transition, perimenopause, hormones are. Erratic and chaotic, and you are getting really high spikes of estrogen sometimes. You're having, ovulatory cycles that produce a second ovulation we call those loop cycles or luteal out of phase cycles. Your estrogen is getting higher stacking, your endometrial lining is, getting thicker, responding to that estrogen. Estrogen causes the endometrial lining inside the uterus, to grow. Progesterone stabilizes it, and when both of those drop, when there's, no baby during a normal cycle, that's, made, right the uterine lighting sheds and you have your period. And that cycle gets really disruptive. We start having more anovulatory cycles eggs aren't being, released from the ovary, which causes those hormonal changes to happen. A lot of people will have, structural, problems, within the uterus. So fibroids, which are a big, problem for bleeding. As we get older and have more medical conditions, maybe we're on medications, have had blood clots in the lungs or legs, pulmonary embolism or DBTs, and have been put on, anticoagulation or blood thinning medications or they're on aspirin increasing their risk for bleeding at baseline. Your periods can start to be longer. They can start to be, heavier. You can start to pass clots when you didn't used to. You can start to have pelvic pain when you didn't use to. You may be bleeding and thinking, oh my God, I'm losing so much blood. Some people will start to have dizziness or lightheadedness, with it. It's also really disruptive to life. It is very hard to work or, manage other people in your life, when you are having to change a pad or a tampon every hour, sometimes for days in a row. I think I've really changed my perspective over the years in terms of how I approach these women. Really starting out with, you get the details of what's going on, but asking them what are they worried about? What is bothersome, what really brought them in. We're evaluating for the development of a low blood count or anemia, so we're checking blood counts. In the perimenopause or premenopausal patient, we're ruling out pregnancy because bleeding can be a sign of a pregnancy in the wrong spot. So an ectopic pregnancy, which, is, potentially a life-threatening, emergency, or a miscarriage. We're doing a pregnancy test. We may be doing an ultrasound in the emergency department to look for any big structural, abnormalities that might be contributing to the bleeding. Most patients, are having really symptomatic, issues. But for the most part, blood counts are usually stable or maybe a little bit lower. Most women probably have a very not satisfying experience, with this complaint when they come to the emergency department. Because we tell them there's not a whole lot we can do. We often consult with our, gynecology, colleagues and, talk about what we might be able to do to help regulate cycles, whether that's oral contraceptive pills to suppress, their own chaotic, hormones. Whether that's high doses of, a progesterone product to stabilize the uterine lining. There's really no quick fix for this. It does take time to sort through what's going on. The, big takeaway for our listeners is, if you have a concern about bleeding, you should go in, we need to rule out, anemia, pregnancy, but then to, understand that really getting at the treatment and the management is gonna take some time to sort out exactly what is going on. Is this too much estrogen? Is it not enough progesterone? Is it something structural? Understanding what we can do within the emergency department. The next steps are following up with, your gynecologist or primary care provider for treatment options.

Dr. Komal Patil-Sisodia 41:49

I can attest to how scary this is because when I was in my thirties, we were struggling with, secondary infertility. I had endometriosis and one of these episodes where the bleeding was like, am I going to bleed out and die? It's terrifying, and you're right. There was not a lot they could do for me other than make sure I wasn't having a miscarriage made sure my blood counts were stable, it was probably one of the most terrifying experiences I've had in my life. Absolutely. It takes a while to get everything sorted through, but I really appreciate, and I know patients who come across you will appreciate the approach you take with them. That is, gentle and filled with explanations. Thank you for doing that.

Dr. Jessica Yearwood 42:34

Oh Absolutely. Most people are usually fine and okay. But I have also taken care of women who I have had to admit for blood transfusions, because things had been going on for so long that, they weren't getting appropriate treatment and intervention. Their red blood cell counts were in critically low, levels. Some of the signs that your blood counts are critically low, you can take and pull down your eye and look at the lining of your conjunctiva. It should be nice and pink. If it's really white and pale, that usually means your blood count is very low. Symptoms of fatigue. You're doing your normal activities, climbing upstairs, cleaning your house, playing with your children, walking your dog, and you're more fatigued or tired or short of breath, or very dizzy or lightheaded. And low blood pressure also go along with having those low blood counts. So if you're having bleeding plus any of those symptoms, you definitely should be evaluated, with that blood count.

Dr. Komal Patil-Sisodia 43:31

Thank you so much Jessica. I appreciate the time you took with me and all of our listeners to go through all of these things that you're seeing come through the er. Anybody who comes across you is so lucky, to be under your care and the fact that you're looking at them from such a compassionate and knowledgeable lens. I don't know many ER doctors who are menopause society certified practitioners as well, so that's really remarkable. I'd love for you to tell our listeners, about your new clinic that you are opening up and where you're going to be located. I was really excited when you told me that you will be, opening up your own, menopause clinic and I wanted to make sure everybody knew about it so they could potentially go see you for their menopause care.

Dr. Jessica Yearwood 44:16

Thank you. This is something that I am super, excited about. I saw this gap in care as I was getting the training and knowledge for myself, I started to think I'm having these conversations with women in emergent. Settings and I can't really do a whole lot, in the structure of, emergency medicine, visit. And, so I, yeah, I decided that, I wanted to open a practice where I could, do some consultative and, direct care for women in perimenopause and menopause. Hopefully if everything's on track, I'll be ready in December to start seeing patients. My, practice is gonna be located in Gig Harbor, here in Washington. So South Sound. I will be, having some telehealth, availability as well. I think for right now, I'd love to see my new patients in person. I think that's a great way to get to know people, and start talking about things. But we'll see if I open up the telehealth to new patients as well. We'll see what kind of interest, and need there is, for that option.

Dr. Komal Patil-Sisodia 45:17

There's a huge need. I predict you'll be busy very soon. What is the name of your practice?

Dr. Jessica Yearwood 45:22

The name of my practice right now is Jessica Yearwood, md pLLC. I'll have my website up and running soon. You can, get that out to the listeners if they're interested in contacting me, see where I am, see what I'm about.

Dr. Komal Patil-Sisodia 45:35

That would be fantastic. And are you on social media, Instagram, TikTok, and, what are your handles for that?

Dr. Jessica Yearwood 45:41

I am on, Instagram right now and it's, Jessica Yearwood, md. You can look me up and, really, as, as a midlife women myself, the social media thing is, certainly challenging. but very fun. I, don't have a lot of content on there, but what I do hope to put on there is educational things. I also have a passion for empowering people to, navigate the medical system making visits with your, primary care or specialty doctor really work for you. Educating, what questions to ask how to get through your concerns. There are so many knowledgeable people out there doing such good work, on social media. I love finding things that people have done reposting resharing and, directing, patients, to those sites so they can, be informed as well.

Dr. Komal Patil-Sisodia 46:29

Yeah. That is fantastic and I'm so excited that, we reconnected and I get to call you a colleague and I'm really looking forward to working with you in this space. Thank you for taking the time today.

Dr. Jessica Yearwood 46:41

Absolutely. Thank you for, starting this podcast. When I came across it, scrolling through social media, I went, oh my gosh, I know her like this. Yeah. I kinda start listening to this and, I just, I find that it is, easily digestible information. You can turn it on in the car. Put it on your headphones when you're cleaning your house. It's really insightful relevant information, that, everyone, is going to benefit from. So thank you for doing this.

Dr. Komal Patil-Sisodia 47:09

Oh, thank you so much. That's very kind of you. To all of our listeners. I will be linking all of Dr. Yearwood information, including her new practice in the show notes for this episode. Please make sure you go over to Instagram and follow her at Jessica Yearwood md and we will see you on the next episode.