S2E4: Pregnancy to Perimenopause with Dr. Emmie Strassberg

In this episode of Reset Recharge, host Dr. Komal Patil-Sisodia delves into the complexities of women's reproductive health with guest Dr. Emmie Strassberg, a maternal fetal medicine specialist. They discuss the challenges women face during pregnancy and preconception, especially for those over 40 or with chronic health issues. Dr. Strassberg shares insights on how mental health, physical health, and coaching play pivotal roles in managing difficult pregnancies and optimizing outcomes. They also explore the impacts of pregnancy complications on long-term health and provide practical tools for women navigating postpartum and perimenopausal transitions. Tune in for an informative and empowering conversation aimed at helping women take control of their reproductive health.

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Audio Stamps:

00:00 Introduction to Reset Recharge
00:59 Focus on Pregnancy Challenges
02:00 Meet Dr. Emmie Strassberg
03:21 Personal Stories and Coaching
04:13 Medical Models and Coaching
06:42 Understanding Reproductive Health
09:02 Emotional Support and Therapy
14:08 Practical Tools for Difficult Pregnancies
16:19 Long-term Health Implications
19:24 Managing Chronic Reproductive Conditions
20:09 Women Taking Charge of Their Health
20:42 Managing PCOS and Pregnancy
21:10 Gestational Diabetes Concerns
22:47 Challenges with Glucose Testing
24:08 Continuous Glucose Monitors in Pregnancy
25:35 Mental Health and Pregnancy Outcomes
26:20 Perimenopause and Postpartum Overlap
28:23 IVF, IUI, and Hormonal Impacts
29:16 Importance of Treating Mental Health
34:18 Preconception Consults and Planning
35:55 Where to Find Dr. Emmie Strassberg

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. Hi everyone. Welcome back to Reset Recharge. I'm your host, Dr. Komal Patil-Sisodia. Today's episode is going to focus on women who are struggling during their pregnancies, have had difficulty in a past pregnancy or have had difficulty getting to a point where they can actually carry a pregnancy to term and in order to discuss that, especially since this seems to happen in women who are 40 plus when they're trying to conceive though it can happen to anybody. I've invited Dr. Emmie Strassberg, who is a maternal fetal medicine specialist. She is also, seeing patients for preconception counseling and pregnancy planning, especially women who have had a difficult time getting or staying pregnant. And we are going to talk about that also in the context of how women who are 40 plus and trying to get pregnant also can hit perimenopause. As they're in postpartum and sometimes it's hard to tell the difference. And there are health implications that happen during a pregnancy that can have, implications for long-term chronic health as well. So I'm hoping to delve into all of that. But welcome Dr. Strasberg. Thank you so much for joining us. We're excited to have you. Can you tell our listeners a little bit more about your background, where you trained, where you are now, where they can find you?

Dr. Emmie Strassberg 2:13

Yeah. Thank you so much for having me. My name is Emmie Strassberg. I went to med school at Nova Southeastern in Fort Lauderdale, so I'm an osteopathic physician. I went to residency in Long Island at Good Samaritan Hospital in West Islip, and I did my fellowship at Geisinger in Central Pennsylvania. And then after that I worked for the last eight years in the Shenandoah Valley in Virginia, at a hospital MFM practice and, which was wonderful.. But since the summer I have left and I'm now, working in a preconception counseling, telemedicine clinic that I've created. And starting that this month, and then I'm doing some other telemedicine on the side as well.

Dr. Komal Patil-Sisodia 2:51

That is wonderful, and your background speaks to itself. I was really excited to see that we had a mutual friend in common, Dr. Dani Henderson, who Oh yeah. Who I work with. And you all know each other, through your societies. Yeah.

Dr. Emmie Strassberg 3:05

And she's also we're involved with the American College of Osteopathic Obstetricians and Gynecologists, which is a great organization. So I know her through there.

Dr. Komal Patil-Sisodia 3:13

Oh, that's wonderful. We run in some of the similar circles working with Dr. Rentea and, have a few other people in common. So it's been really fun to get to know you. Let's talk, about your core coaching work. There are so many women, myself included, and I've shared this story. Four who have had multiple pregnancy losses for the listeners out there. I was able to get pregnant pretty easily with my son, and after that I was not able to stay pregnant. So this particular topic is near and dear to my heart because as somebody who went through multiple miscarriages trying to have a second child and then eventually gave up, I wish that I had found a doctor like Dr. Strasberg. Somebody who's educated, somebody who is compassionate, somebody who can give you hope in this next stage of life. Because too often women go through this alone. And I will say it's probably one of the most isolating times in my life. You just don't know what you don't know. And even me as a physician, I didn't know where to turn and or who to go to. So I would. Love to hear from you the difference between the traditional medical model that we see, women, because I did see an MFM,. But I think what you're doing is like MFM plus or MFM 2.0 is what I'd like to call. How do you look at the difference between those two?

Dr. Emmie Strassberg 4:32

Yeah, so actually back in 2020, I went and got a life coach certification through the life coach school because I really wanted to be able to provide more to my patients than just a short office visit. Yeah. Because I have found that so many women are just going through so much in pregnancy and pregnancy makes it harder and our medical system doesn't make it easier. And so I did do some pregnancy coaching for a while separate from being a physician. And now when I'm doing this preconception counseling work, I'm just sort of incorporating that into the medical practice. Yeah. Where we can go more in depth and really look at everything that's going on in a person's life and really figure out what they need to have a healthy conception, a healthy pregnancy. Yeah. I'm so sorry that you went through that with the multiple miscarriages. So many women do, and it's just so sad to me that everybody feels so isolated because there are so many people out there with this Yes. With this issue. And they often do get overlooked. I just actually had somebody comment on my social media on a post that I made about recurrent pregnancy loss, that she'd had nine losses and felt like nobody had done anything about it. And that's just really sad because there's so much we can do for that. There's a lot of things that we can look into, and it just takes the time and the effort. And the problem with being in a hospital focused, maternal fetal medicine practice is that you're very busy and your priority has to be the high risk pregnant patients because they're on a strict timeline. Yeah. You can't push off any of their visits for months. But preconception counseling, so pre like pregnancy planning, that isn't as prioritized because they're not pregnant yet, which is silly, but. That's just the way it is. So I was the one in my practice that did these consults and I kind of had to fight for the time to do them. And then of course when you're talking about like reimbursement, they're not reimbursed as much as say, an ultrasound and No. So they just, they don't get prioritized the way they should.

Dr. Komal Patil-Sisodia 6:24

Yeah. And i'm just grateful to hear that there are people like you out there who can do that I made my peace with my process and I have some thoughts about it that I've gone back and looked over my medical records and whatnot and I think there were probably some things that could have been done, but hindsight is 2020 and here we are today. Can you tell our listeners a little bit about how what you do is different than reproductive endocrinology or the. Process of getting pregnant through IVF and IUI. Because I know in our conversations, like in my mind, it all runs together. And if that's happening to me, that's gonna happen to our listeners and I want them to know the difference because you're not a reproductive endocrinologist, right?

Dr. Emmie Strassberg 7:04

So this is like the one area that maternal fetal medicine, high risk pregnancy specialists and reproductive endocrinologists, or IVF fertility specialists come together a lot in that. A lot of the times when women are going through fertility workup, their doctor who's doing the fertility workup, who is not me. Finds things like recurrent pregnancy loss or chronic health problems or other concerns that they want the woman to speak to a higher risk pregnancy specialist about, before they get pregnant. I see. So what I do is more pregnancy planning. Planning for a healthy conception. Not the conception itself. Yeah. And there are some things that I can talk to patients about, lifestyle changes, that can of course help move towards better fertility. Yeah., But the actual fertility workup, management and treatment is done by a fertility specialist, also called a reproductive endocrinologist. Yeah. Also called

Dr. Komal Patil-Sisodia 8:01

IVF, you know, specialists. Yeah, and it's interesting because as an endocrinologist, I have a lot of people call my office and say, well, do you do IVF and reproductive endocrinology? And I'm like, no. Different kind of endocrinologist. Yeah, exactly. Different kind of endocrinologist. So the terminology is very confusing and so it's always nice to have a reset there. So I imagine you. From my own experience and probably from what I've seen in my office, because I do see a lot of these patients, one of my areas of interest has been thyroid disorders in pregnancy. I think we talked about that a little bit. I see a lot of these patients come into my office as well, and it is such a complex time,, in their lives in terms of all of the emotions that are going through. And people feel, I know I felt very broken during that time. Like my body just wasn't doing what it was supposed to do. That. All women have done for, centuries and like I was telling myself tales in my head about like how I was the only one who was failing at this. How do you help your patients, recognize that, validate what they're feeling, and work through that process, because that's a big piece of this if you're not in a good head space, how are you going to get to the next step of trying to actually conceive?

Dr. Emmie Strassberg 9:09

Well, I think identifying the problem is really helpful. Because you think about a car, if your transmission is not working, it's not that, you have a car that's never gonna work, you just need to replace the transmission. I don't know much about cars, so, yeah, that might be a silly analogy,, but yeah, so, it's not a moral problem. And I think too much society tells the story of well women, we're meant to have children. If you can't do that, then there's something wrong with you. Yeah. Or if you can't do it the right way, then there's something wrong with you. And I think women internalize that a lot. And there's no right way to be a pregnant person., Everybody's body is different. Everybody's pregnancy is going to be different and everybody's health is going to be different. And that includes pregnancy. And really separating that from you as a person that has a body and a health condition can be helpful. And some of that really needs a therapist more than me, it's not that there's nothing wrong with your body it's more that, every body has a certain capacity for health that's, Osteopathic principle, and we want to move that, we wanna move towards that capacity.

Dr. Komal Patil-Sisodia 10:09

That's really a lovely way of reframing it, that your body is doing a certain thing, but we can work around the things that they're doing. So how do you use your coaching principles? I know you alluded to some of this has to. B dealt with in therapy, which I went down that road, so, yes. Yeah, and it was really helpful actually. But for you, how are you using your coaching principles to help draw that out and how do you make a determination for when coaching will be enough versus when you send somebody to therapy?

Dr. Emmie Strassberg 10:39

First of all, you always have to get consent for coaching. You never wanna coach somebody who has not given you their consent to coach them. Because a lot of people are not in a place where they want to be coached. They are having a problem, they don't wanna think about it any other way, and that's what it is. But if they're open to thinking about something differently, sometimes you can bring in curiosity, which is one of my favorite coaching tools. That's so interesting that that's how you see this. Is it possible that we could also look at it this way? Instead. Or what else might be possible. So just reframing the perspective around the story they've told themselves about their pregnancy or their prior bad outcome or difficult outcome. Is. I think that's great. Sometimes the stories that they're telling themselves are like far from actual facts. So just being able to receive the factual medical information, no, this is actually what happened. There's nothing that you could have done to prevent this. And actually what your doctors were doing was the best they can to save you and your baby. But that maybe wasn't communicated the best in the moment. Yeah. Sometimes that can be really helpful just to get a fresh perspective.

Dr. Komal Patil-Sisodia 11:49

And I love that you are focusing on that because so often when you go into like your standard OB visit or even a visit at. A very busy MFM clinic. You're booked in 15, 10, 15 minute spots go through, the workup and then move on to the next one. From experience, I know that that's really hard you know, it's unfortunate that our healthcare system is. Set up in a way that we don't have the time to give women who are going through this, that type of attention. Could you share an example with me of how you've helped somebody kind of understand a past diagnosis that was very difficult. Like, we see, intrauterine growth restriction, or, complications of preeclampsia or premature rupture of membranes, things like that, that, they're blaming themselves, they're blaming their body, they're blaming whatever it was they were doing in that pregnancy. Can you share an example of like how you've helped somebody come through that and feel empowered before their next pregnancy?

Dr. Emmie Strassberg 12:53

Honestly, one of my best examples is from one of my coaching clients. I don't wanna give too much detail'cause No, I have permission to share the story, but she had a very traumatic delivery experience that ended with a healthy mom and healthy baby. But Oh, that's, so the experience itself was really disturbing to her. And so we just debriefed everything that happened. And what happened is they had to move quickly to get her baby delivered. Mm-hmm. So they didn't really end up communicating super well with her. And so she had no idea why things happened the way they happened. And so just to be able to talk like, well, this is probably why this happened and that happened, and it doesn't really sound like anything went wrong except for that nobody really. Made sure that you understood what was

Dr. Komal Patil-Sisodia 13:35

happening. Yeah. Oh gosh, that's so hard. And that's the crux of it, right? People just want communication. They want to be heard,, they want to feel like their experience is validated. And that. It's not, them that's broken. So I love that you were able to break that down for her and get her to see that, in an emergency, we're not gonna have time to sit and chat like this. Right? It's gonna happen. Go, go, go, go, go. But they did everything to the best of their ability and. It sounds like it was a great outcome for all. So that's really good. That is really good. What is one kind of practical mindset based tool that you recommend to women who are coming off of a very difficult pregnancy, or a prior loss? What's a good tool that you give them to stay regulated during their next pregnancy? Because that's hard. Oh yeah. That's really tough.

Dr. Emmie Strassberg 14:30

I think for losses, one of the things that's really shown to help in future pregnancies, especially if it was a baby that they named, is to just focus on remembering that baby. Yeah. Because that baby will come up. I mean, you're gonna be in the same ultrasound room, you're gonna hit the same gestational age or the calendar date or something, and it's going to come up. And remembering and celebrating sometimes can help a little bit. Therapy is really helpful. And that's not like a tool or anything, but really if you're struggling with, it's almost like PTSD in that point. So yeah. Therapy can be helpful. But just grounding exercises, square breathing. Meditation, all of that stuff can be helpful as adjuncts. And then journaling is a really great tool. It's not for everyone. Not everybody likes to journal, but being able to get your thoughts on paper if that's something that works

Dr. Komal Patil-Sisodia 15:18

for you, could be really helpful. That's great. So there's lots of tools that people can have. Are, do you know, or do you have in your area any support groups for women who've gone through multiple losses or bad outcomes or anything like that? I feel like that would be so helpful if I knew, yeah,

Dr. Emmie Strassberg 15:36

I know they exist. The problem is and especially with some of the online groups, is that it can be really frightening or. Yeah. Like triggering for some overwhelming people when they start, people start posting about bad things that are happening to them. Yeah. Or that happened to them. And then the next person's reading is like, oh, well, is this gonna happen to me? So sometimes they can be helpful, but it just, it really depends. Yeah. I don't know of any in-person groups where I am. There's some good organizations that, do a lot of support. Like the Preeclampsia Foundation is great. Mm-hmm. And, recurrent Pregnancy Loss Association is another great organization that does a lot of patient advocacy work. And I know they have some support resources.

Dr. Komal Patil-Sisodia 16:18

Well, that's great. What I'll do is I'll make sure I post those, in the show notes below so that people have that, and there's so many different types of pregnancy complications that you can have. As an endocrinologist I deal with. Preexisting diabetes or gestational diabetes or even thyroid dysfunction. But you see a different side of things with the preeclampsia, with additional complications on top of that. Can we talk a little bit about that and how those. Conditions connect to future cardiovascular or metabolic health, because I think that's important for people to know, right? Because sometimes you have a bad outcome in a pregnancy, or, you have a complication in a prior pregnancy that then affects your health and may affect your fertility in a way. And I don't know that we always talk about that or what the long-term risk for women will be when they've had gestational diabetes or high blood pressure during pregnancy or something like that.

Dr. Emmie Strassberg 17:13

Yeah. I mean those are the two big ones for chronic health. So gestational diabetes, you have like a 50 to 70% chance of developing diabetes later in life if you have gestational diabetes in pregnancy.

Dr. Komal Patil-Sisodia 17:23

Yeah. And of

Dr. Emmie Strassberg 17:23

course there's not nothing that you can do about that.

Dr. Komal Patil-Sisodia 17:26

Yeah.

Dr. Emmie Strassberg 17:26

And same with, preeclampsia will increase your risk for cardiovascular health. I'm having trouble remember the number off the top of my head, but I think it's like 60%. Wow., Yeah. Cardiovascular. But, you know, cardiovascular disease is the number one killer of women anyway. So that's already higher risk for women. But if you have preeclampsia, you're at a higher risk.

Dr. Komal Patil-Sisodia 17:44

Okay. And that's good to know. So, you know, with having that just one time though, right? Like in one pregnancy, that's the percentage risk of increase.

Dr. Emmie Strassberg 17:54

The more severe it is, the higher the risk leader in life. To the point that when I was at, in my fellowship, it was protocol that if patients had what we call like severe preeclampsia Yeah. They would be seen by a cardiologist. We had like a, agreement with cardiology that they would then get these patients in and just do like a baseline cardiovascular evaluation and then, make sure that they weren't. Completely lost a follow up. Yeah.

Dr. Komal Patil-Sisodia 18:17

Yeah, that's, I mean, I think that's great. I know we talked about, in my fellowship, we worked very closely with the MFM team as well, and we ran a joint endocrine slash MFM clinic for the thyroid dysfunction and pregnancy. Mm-hmm. And also gestational diabetes in pregnancy. And you know, one of the things that I see in my practice is that women who've had gestational diabetes during pregnancy. A lot of them, they get so busy postpartum, they don't come back for their three month mm-hmm. Postpartum glucose tolerance test to figure out whether the diabetes has resolved or not. And so sometimes it just goes unchecked for years. I know for me my primary care doctor still makes fun of me because I went to establish my first visit with her and she was like, when was the last time you saw a doctor? And I gave her a date. And she's like, so your postpartum visit with your gynecologist, it was like five years later at this. Point. Yeah. I guess I'm lucky that nothing bad happened in the meantime, but it is hard to find that time to come in and actually take care of yourself. So a hundred

Dr. Emmie Strassberg 19:17

percent And mothers are doing so much, they're taking care of their families. They're working.

Dr. Komal Patil-Sisodia 19:21

Yes. Life happens,

Dr. Emmie Strassberg 19:23

you know,

Dr. Komal Patil-Sisodia 19:24

It really does., Let's talk a little bit about common reproductive health challenges that kind of occur between. Pregnancy and perimenopause, like PCOS development of fibroids, things like that. What is the biggest misconception women have about managing their chronic reproductive conditions in their thirties and forties? And we can toss endometriosis and adenomyosis in there because again, this is something that I went through and totally ignored because I thought that there was nothing to be done at this point. That's not the case. Women have options. They can get treatment and things like that. From your perspective, how do you start talking to your patients about that?

Dr. Emmie Strassberg 20:09

Yeah, I think, what's really, encouraging is a lot of women are getting on top of that,, more than their doctors, honestly, sometimes.

Dr. Komal Patil-Sisodia 20:16

Yes.

Dr. Emmie Strassberg 20:17

They are educating themselves about their, endometriosis and PCOS and all of that and, I've had several patients that have had, those concerns brushed off in the past and, then they get pregnant. And, endometriosis sometimes can have complications in pregnancy. Sometimes it gets better with pregnancy. Oh, really? Yeah. Some people have, improvement of symptoms with pregnancy and postpartum treatment. Okay. But others don't. Yeah. And, as far as PCOS, I think you just need to find a doctor that knows how to manage that correctly, because it is so confusing with, when is my cycle gonna happen and when am I ovulating or not ovulating? Yeah. Do I just go on birth control pills? And it depends on if you wanna get pregnant or not. The treatment's obviously very different. Yes. And then is there insulin resistance? And if there is and you want to get pregnant, how can we work on that before pregnancies? Yeah.

Dr. Komal Patil-Sisodia 21:09

Yeah. I see a lot of my PCOS patients go on to unfortunately develop some degree of gestational diabetes during pregnancy. If they had insulin resistance subtype. And I think that's the hard thing about PCOS to your point,

Dr. Emmie Strassberg 21:23

What I find is even, sometimes their gestational diabetes tests, the one hour, which is like the initial challenge test will be elevated and even like mildly elevated, like one 30 to, I don't know, yeah, one 40. And then sometimes they'll do the three hour test and that will be normal. Or they'll one elevation, but otherwise, technically they don't rule in for gestational diabetes, but they still end up having sometimes some of the complications that we see where baby's measuring really big

Dr. Komal Patil-Sisodia 21:48

or

Dr. Emmie Strassberg 21:49

there's extra amniotic fluid. And sometimes we still see some of those. Gestational diabetes type, not as strongly as if they had gestational diabetes. We still see some things like that.

Dr. Komal Patil-Sisodia 22:00

That's interesting because I remember when I was pregnant with my son, that was the year that the cutoff for that one hour test went from one 40 to one 30, and I think I was right at that one 30 and they were like, you have to do the three hour test. And I was one of those people That was totally fine. But now, I think back and I'm like, who knows?. Well, it's interesting, so,

Dr. Emmie Strassberg 22:21

The cutoff of one 40, a lot of people still use that and it really should depend on what your population is. And honestly in this day and age that's fair. One 30 is probably decent cutoff and I've known people using 1 35. So it just depends. Yeah. But if I have a patient that has PCOS or they, have obesity or they have

Dr. Komal Patil-Sisodia 22:39

yeah,

Dr. Emmie Strassberg 22:39

any risk factor for insulin resistance and they have a one 30, then I will have them do the three hour test. Much to their chagrin and honestly I feel like we could come up with better testing.

Dr. Komal Patil-Sisodia 22:51

Oh my gosh, whatever that concoction is. I remember sitting there in the one hour test and I was in the lab and it wasn't just like an OB lab, it was. A lab with a bunch of other people, and I drank that, what is it, like 50 or 75 grams of glucose? The three

Dr. Emmie Strassberg 23:07

hours, a hundred grams of glucose? No, no,

Dr. Komal Patil-Sisodia 23:09

this was the first one. Oh, that

Dr. Emmie Strassberg 23:10

one's 50. Yeah,

Dr. Komal Patil-Sisodia 23:11

50. Right. And all of a sudden you just see my belly rippling like this. It was like my child was trying to bust out and the man sitting next to me, he was like staring at my stomach and he's like. Are you okay? I think he thought like a gremlin was gonna shoot out of my belly like alien. Exactly. Because I was like, wow, he is like getting hopped up off of sugar. He is like, you see like all this movement along the way, but yeah, we need to come up with better testing for women.'cause that was not a pleasant experience for either of those tests. Possibly worse for the second one because there's less room by that point and more sugar. So,

Dr. Emmie Strassberg 23:50

well, I've had patients that can't even tolerate, they'll do a three hour test and then they throw up in the middle. So you can't really make it, it's not accurate. And so then sometimes we do alternative testing, which is. Not great because it's not as well studied. Yeah. So basically have people check their blood sugars four times a day for one to two weeks and, see what's happening. Or now we're getting a little bit more into using CGMs. I was just gonna ask

Dr. Komal Patil-Sisodia 24:12

that question. Is there a particular one that you prefer in pregnancy?

Dr. Emmie Strassberg 24:16

Not particularly. The two ones that I know about Dexcom and the Libres, I think the Dexcoms are more likely to be, at least where I was, they're more likely to be covered by insurance. But,

Dr. Komal Patil-Sisodia 24:26

um, yeah, no, that,'cause we had a good Dexcom rep. I think that's a great point. Yeah. I think that I have

Dr. Emmie Strassberg 24:34

received no money from Dexcom. Yeah.

Dr. Komal Patil-Sisodia 24:35

Neither have I. Or Libre, but I use both equally. They're both excellent products, so I just wasn't sure if there was an edge for one over the other in pregnancy, so,

Dr. Emmie Strassberg 24:45

yeah. It's so interesting when people think about it too. Like I had a patient the other day that was like, do I really have to check my blood sugar four times a day? Like, you're telling me I have to do this, rest my pregnancy, I have to prick my finger. I said, well, we could see if you're,'cause she was a pre gestational, we could see if you're, insurance will cover a continuous glucose monitor, but she thought that was even creepier. She's like, it's just gonna sit in my skin for two weeks.

Dr. Komal Patil-Sisodia 25:05

Yeah, I know it really comes down to the individual person's tolerance of what they're, yeah.

Dr. Emmie Strassberg 25:10

It's less invasive than pricking your finger. Really.

Dr. Komal Patil-Sisodia 25:13

I agree. I get to play with all of those things. Yeah.'cause the reps bring them to my office and I would much rather,. Well, one, I'm needle phobic. They call me doctor chicken at the lab because I'm very drunk when they draw my blood. But I would wear the continuous glucose monitor if it were up to me.'cause I don't like poking my fingers so right know., But it's what it is different for each person, for sure. And you know, you talked a little bit about how like women are doing so much more education in terms of knowing what's going on with their health, and I love to see it mm-hmm. Because as physicians, you and I both know that women haven't been included in medical studies for the better part of. All of history. Yeah, exactly. Just since 1993 did we actually make it into a study. And then that got shut down, not even a decade later for a little bit with the Women's Health Initiative mm-hmm. We kind of shied away from doing stuff with women again., But now,. We are seeing women be more educated about pregnancy and what that means for them. I'm also seeing it for the women who are hitting perimenopause because this is where I start to see endocrine disorders get significantly worse. And one of the things is that for women who are having babies in their forties, what I'm finding in my practice, and I'd love to hear more from you on, is that transition from being immediately. Postpartum to then hitting perimenopause and what that looks like sometimes, because not only is perimenopause starting to increase your risk for all of those metabolic health conditions, like higher blood sugars, higher blood pressure, higher cholesterol, but you're also having all these other symptoms, that can overlap with those of postpartum. So how do you, or have you had to help your patients sort that out a little bit?

Dr. Emmie Strassberg 26:54

Well, I don't normally see people that are postpartum because once they're, done being pregnant, they're ob gyn but I will see them pre-pregnancy if they're planning another pregnancy. Yeah. But it is difficult because, the pregnancy hormones and pregnancy brain's a real thing too. And then you get to perimenopause and that can be really difficult. And then you have a newborn. So how much time are you really taking to go see your own doctor for yours? Five years later, perimenopause that you probably just assume is postpartum.

Dr. Komal Patil-Sisodia 27:22

Yeah.

Dr. Emmie Strassberg 27:23

Stuff.

Dr. Komal Patil-Sisodia 27:23

So, yeah. And it's hard because the postpartum mood disorders as well, do you see a higher rate of that in women who have gone through a difficult pregnancy or a bad outcome? Higher risk for postpartum anxiety or depression?

Dr. Emmie Strassberg 27:41

Sometimes there is, yeah, sometimes there is. It's interesting. People are just all very different. I've also had plenty of patients that,, seem to be not unaffected by loss, but they take it very differently. And then they're not anxious in the next pregnancy. And I always really wonder how those people get to where they are amazingly People just cope very differently and I don't know if it has, necessarily anything to do with, that or not. But that said, if you've had past abnormal pregnancy outcomes or, complicated outcomes, it is going to be a little bit more likely that you're gonna have anxiety For sure. And even depression. In the next pregnancy and postpartum. Okay.,

Dr. Komal Patil-Sisodia 28:21

Good to know.

Dr. Emmie Strassberg 28:23

Yeah. And then in vitro, I've noticed too, sometimes obviously there's some higher anxiety with that because just the anxiety of getting pregnant has been so high and then you are pregnant, so you think that you're going to be, relaxed because now you're pregnant, but now you're not relaxed'cause you're pregnant and you want the pregnancy to have good outcome. And then you think you're gonna be fine once the baby is born, and then you're have a child and have to deal with all of that. So

Dr. Komal Patil-Sisodia 28:46

It's a lot. I've had a lot of my patients go through IVF and IUI and even just the process of the degree of the hormones they give during the egg retrievals and things like that, or the continuous progesterone that people have to be on. All of the mood changes that I see with that is very interesting too. And how much of it is that they wanna actually have to go through this process and that's what's stressing them out versus how much of it is the actual side effect to some of the hormones. I don't think we know that particularly well, so.

Dr. Emmie Strassberg 29:16

Well, one thing I will say is that women who have baseline depression and anxiety that's not treated

Dr. Komal Patil-Sisodia 29:22

Yeah. Have

Dr. Emmie Strassberg 29:23

a much higher risk of adverse pregnancy outcomes if it's not treated

Dr. Komal Patil-Sisodia 29:28

interesting.

Dr. Emmie Strassberg 29:29

So, making sure that mental health is treated is also really important. And that sometimes, I feel like that's sometimes a newer approach yeah. I still have patients that come and they're on multiple psych meds and they said, well, my psychiatrist just said to stop all of them because I'm pregnant, and they'll see me when I'm done being pregnant. I'm like, Ooh, that's not great. No. Luckily there are also some really, really great psychiatrists that I can coordinate with and we figure it out and we make sure the patient's well taken care of. But to be mentally not well or super stressed, does influence pregnancy outcomes as well and neonatal outcomes. And even bonding between mom and babies. I went to a really fascinating conference in, I think it was 2019, at the Fetal Brain Institute in dc which is at the Children's National. Yeah. And, they did a full conference on maternal mental health and how it affects the fetal brain. And it really affects it quite significantly weirdly male fetuses are more affected than females. Huh. Yeah.

Dr. Komal Patil-Sisodia 30:27

I wonder why that is. That's so interesting to me. I

Dr. Emmie Strassberg 30:29

think it has to do with hormones,. But what they found is that, women who had like higher ACE scores, so adverse childhood event scores, had more complicated pregnancies and then more difficulty bonding, and more chance of a child that had difficulties Wow. As well., So those things also need to be addressed and also need to be,. Treated optimally preconception, if possible. Yeah. And then through pregnancy so that we can make sure mom and baby are healthy and having good bonding, and good postpartum experience.

Dr. Komal Patil-Sisodia 30:59

Yeah that I think is fair. I think. People are so scared of everything that they're doing during their pregnancies like, is taking this Tylenol safe for me in pregnancy? And unfortunately right now we're getting really bad advice around that, mm-hmm. I remember when. I was pregnant, I had heartburn, so I took, what was it called? Zantac or something, and then it got recalled later, And I was like, oh no, I took this during my pregnancy. Or there's so many different things that, we get very afraid of doing during that time. I have a lot of patients who are afraid to be on their anti-anxiety or anti-depression meds. Yeah. Because they worry about that. But there are, from what I'm hearing from you, there are safe ones for pregnancy, correct. Yeah. And the safe is really

Dr. Emmie Strassberg 31:43

not the word I like to use., it's not a fair word for the situation, but, when you look at risks and benefits, the benefit of being well controlled on most honestly most psychiatric medications, there's very few. I think Depakote is like the one that they're like, please don't use this medication in pregnancy. Yeah. The benefit. Outweighs that risk most of the time because that benefit of good maternal mental health, good maternal and neonatal bonding is gonna outweigh that risk. And they've done studies looking at women who are untreated and they have similar rates of neonatal withdrawal type symptoms or interesting NICU admission. Then women on the medication. So is it really the medication or is it just the, disease process itself or We don't know, but we know that women who are optimized.

Dr. Komal Patil-Sisodia 32:28

Yeah. Outcomes. Yeah. Yeah. So it sounds like from your coaching perspective, there's so many different things that we have to talk through, especially for women who have been through a recurrent pregnancy loss or previous bad outcomes, to make sure that they're getting a really nice, comprehensive picture of all the different things that they can do. And I'm gonna quote you, and I hope I don't say it wrong, but to the capacity of your body, which is that, is that you said,

Dr. Emmie Strassberg 32:56

I think that's basically what I said. Yeah,

Dr. Komal Patil-Sisodia 32:58

yeah, yeah. And I like that term, right? Because your body is made the way that your body is made, your genetics are your genetics. And you work with what you have. It's not to your point, a moral failure that, you inherited this from like generations of people in your family. That passed it down. That's not something that was, the hand of cards you were dealt. So I think taking the blame off of people is such a beautiful thing because, we are our own harshest critics, especially as women. We are so nitpicky with all of the things that we're doing. I am just deeply appreciative that we have somebody like you who is mystifying all of that for our patients. I really love that, you're focusing on empowering them. You're focusing on educating them. You're focusing on making sure that they have tools that they can use, even postpartum. I know we wanted to talk a little bit about perimenopause and how women later in life who are delivering later in life can sometimes go straight into perimenopause. I think that part of that is also education yeah. And being aware of all of the different things that are happening. What are some key, messages that you want our listeners, especially women, who are currently going through this process? What do you want them to know in terms of their reproductive health and what they should be looking out for? And what is it?

Dr. Emmie Strassberg 34:20

I think just that,, having a pregnancy planning visit, a preconception consult can be really helpful, especially if you have had complications in previous pregnancies or you have chronic medical problems, or you have family history of genetic illnesses. It can be really helpful to talk about these things before pregnancy one, so we know what to expect. And two, so that we can optimize the chances of a healthy pregnancy before conception. And so basic things like, prenatal vitamins, everybody should be on a prenatal vitamin. If you have the at all capacity to get pregnant, prenatal vitamin is gonna be helpful to you. And luckily in this country, most food is fortified with folic acid. So, God forbid you get pregnant and you weren't taking a prenatal vitamin, you're probably fine. But if you want that benefit, take it, one to three months before pregnancy and yeah. Make sure you're up to date on your vaccinations because we don't wanna get infectious diseases while pregnant and there are certain vaccines that we can't get while pregnant. Knowing your family history. So if you don't know it, maybe talking to your parents or your partner and their parents and siblings and probably don't need to go past beyond that. Yeah, any previous children with health problems. So all that stuff is just helpful to think about before pregnancy. And, maybe it's not for everyone. Maybe people just like to go in and not think about it. And there are plenty of young women that do that and older women, and that's fine. But if you want to have more information and optimize your health, then that's a great option.

Dr. Komal Patil-Sisodia 35:47

Yeah, that's fantastic. And like I said before, had I been able to find somebody like you, I definitely would have come to your practice. So can you tell us where you are seeing patients and how patients can find you if they do feel like they want to schedule, a counseling session with you?

Dr. Emmie Strassberg 36:05

Yeah, so right now I am starting out in Virginia and Alaska. I live in Virginia, so I know a lot of people here. And, i'm already licensed in the state, so that was an easy place to start. And then I'm gonna be doing some work in Alaska this year with a friend of mine. Cool. Shout out to Carina Mueller and, Aurora Fetal Medicine in Anchorage. I'm gonna be doing, some locums work for her and, I have an Alaska license for the other telemedicine practice as well, so I thought I would. Also incorporate both. Yeah. Since I'll be meeting with people in person there, I really like connecting with people in person too. I know it's weird'cause I'm doing telemedicine, but it's nice to have that network of like doctors you've actually know.

Dr. Komal Patil-Sisodia 36:40

Yes.

Dr. Emmie Strassberg 36:41

And it's fine to have ones that you don't know, but you know, yeah. A good place to start.

Dr. Komal Patil-Sisodia 36:44

Absolutely, absolutely. Well, the people of Virginia and Alaska are very lucky to have you seeing patients there., I will, link your website. And then can you also list your socials for where people can find you online? Oh yeah.'cause I watched your content and you put out some really great videos for stuff that women need to know going into, preconception planning and pregnancy planning. So.

Dr. Emmie Strassberg 37:09

Yeah, my, Instagram and TikTok handles are Dr. Emmie Strassberg, all one word. Yeah. And my website's dr Emmie Strassberg.com. So pretty easy to find all of those. Love

Dr. Komal Patil-Sisodia 37:18

it. Okay. Alright, well I will go ahead and make sure we link all of that. So people can find you. Thank you again for taking the time. Yeah, thank you so much to be here. I think that what you're doing is such a gift to women and your patients and, counseling clients are going to be very, very lucky to have you in their corner. So thank you and everyone, thanks for tuning in. I will see you on the next episode.