Episode 066: Menstrual Health Across the Lifespan

If you’ve ever been told to “push through” your period pain, heavy bleeding, or sudden mood swings, we want to give you a better baseline and better language for getting help. We’re sharing a Menstrual Hygiene Day webinar replay with Dr. Dombo, a board-certified OB-GYN and menopause-certified practitioner with a cross-cultural lens on how women experience periods, stigma, and care gaps.

We break down the menstrual cycle in plain terms (follicular phase, ovulation, luteal phase) and connect estrogen and progesterone changes to real symptoms that show up at home and at work. We also get specific about what isn’t normal: soaking through pads or tampons hourly, bleeding longer than seven days, or cramps that regularly derail school, work, or life. Dr. Dombo explains how conditions like fibroids, endometriosis, thyroid issues, and clotting disorders can hide behind “it’s just my period,” and why racial and ethnic disparities lead to delayed diagnosis for too many women.

From there, we zoom out to perimenopause and the menopause transition, including why symptoms can ramp up even when your periods still look “regular.” Sleep disruption, brain fog, anxiety, shifts in libido, vaginal dryness, bladder changes, and even dry eyes can be part of the picture, and hormones can deeply affect mental health through neurotransmitters like serotonin and dopamine.

We end with practical self-advocacy: track your cycle and symptoms for three months, name details with clarity, and consider telehealth options like Alloy Health to expand access while still partnering with your local clinician. Subscribe, share this with a friend, and leave a review so more people stop normalizing suffering and start getting answers.

Websites: 

www.myalloy.com

NaturaAI: www.mynatura.ai

Website: https://www.midovia.com/
Instagram: https://www.instagram.com/mymidovia
LinkedIn: http://www.linkedin.com/midovia
Email Us: info@midovia.com

MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness & supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.

The information, including but not limited to, text, graphics, images & other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. 

Transcript

Welcome And Webinar Replay

SPEAKER_00 0:00

Welcome to the Medovia Menopause Podcast, your trusted source for information about menopause and midlife. Join us each episode as we have great conversations with great people. Tune in and enjoy the show. Hey everyone, this is actually a webinar replay that we recorded on Menstrual Hygiene Day with Dr. Dombo with Alloy Health. It's such a great conversation. We wanted to share it with our podcast audience. So we hope that you enjoyed this replay. Let's go ahead and get started so that we can finish up at the top of the hour. I do want

Why Menstrual Hygiene Day Matters

SPEAKER_00 0:39

to start off by just saying welcome and happy menstrual hygiene day. Today is menstrual hygiene day. And for those of you that are not familiar with 528, menstrual hygiene day was chosen because we menstruate on average for five days every month, every 28 days. So 528 is menstrual hygiene day. I spent a significant amount of time in the menstrual health space prior to moving and shifting into the menopause space. So this is a day that is very near and dear to my heart. It's a very important topic, and we are absolutely thrilled to have Dr. Dombow with Alloy Health with us here today. Thank you so much, Dr. Dombo, for joining us. You are a prescribing OBGYN with Alloy Health. And I'm wondering if we can start off by you telling giving us a little bit of your history and telling us why this is so close to your heart.

SPEAKER_01 1:39

Yeah.

Dr. Dombo’s Global Perspective

SPEAKER_01 1:40

So I am a board certified OBGYN. And first of all, thank you, April, for um for having me. And uh I am honored to be able to just really break down, you know, um all the different things around menstrual health and what that is, what that looks like because education is is so important and where I think it all starts. Um so I'm an OBGYN board certified and I've been in practice for 20 years, and I'm also a menopause society certified practitioner. Um I have had the opportunity to practice, um, not only here in the United States for majority of my career, but I've also had the opportunity to um work in other countries like Cambodia, Sri Lanka, El Salvador, you know, did some volunteering in Haiti. So I um I have this cross-cultural perspective when it comes to the way that women relate, you know, to our periods, um, pregnancy, uh, you know, postpartum, and then life after, you know, including, you know, the menopausal transition. And why this is so near and dear to my heart is that um we are not like across the board, we are not taught, you know, about what is normal. And I think I see this even in other cultures, you know, there's certain aspects where, you know, you have your period, but not really knowing what's the what's a normal baseline. And um women tend to uh either ignore, you know, symptoms or um experiences that they have and think that this is normal. I know in a lot of developing countries, women, you know, some of the girls may stay home, you know, when they're on their period and they don't go to school because they just do not have the hygiene products um, you know, to be able to manage that. And they're not, you know, adequate toilets or, you know, areas where they can actually navigate having their period, you know, in public. So um I I I truly love being able to educate and being able to talk about this because it's just a part of a huge part of our lives as women that we may not necessarily know what is normal and what is what what what should we possibly, you know, bring to our doctors. And I would love to be able to um, you know, to talk about it and and normalize that conversation.

SPEAKER_00 4:13

Yeah, I love that. And you you brought up so many good points here. Um, and I think the same holds true not just in developing countries, but here in the US and developing countries as well. You know, we are as as young, young ladies, young girls that are just moving into that pubescent stage, adolescent stage, we don't get that menstrual health education. And really, as we move through different life stages, that doesn't change. Um, it's not like at one point in time someone says, Hey, let's teach you about menstrual health, right? It starts really early or doesn't start early, and then that carries with us, and we're just not having the conversation. And you're right, um, menstrual health is so important because it crosses many life stages. We menstruate, I think on average, what, 8,000 days in our lifetime, if we think about that, 8,000 days, and it's something that we are not talking about. And education is so important, you know, we we don't know what we don't know until we do, and then we do better, and we can make healthy choices for for our overall well-being when we are educated. I'm curious, um, and and let's just set the stage here.

Why Menstrual Health Stays Taboo

SPEAKER_00 5:28

Why do you think we're not talking about this, especially in the workplace? And that's where we sit um primarily is in the workplace, but why aren't we having this conversation?

SPEAKER_01 5:38

Yeah. I think menstrual health, or I believe that menstrual health has historically been dismissed or treated as taboo, right? Even in medicine, you know, gynecologist, we're taught what's normal, but typically, like in general, you know, it's your your your anything around your period is considered taboo. And I think many women are told that things are normal. Um, and the learned behavior is really just to push through. Okay, I'm just gonna push through. And, you know, you show up to work, you perform, you figure out how to do what you need to do, and yet we still are suffering, you know, through that. And um, and again, just as I mentioned, you know, we do not teach women what a healthy menstrual cycle looks like. Um, there's no baseline for comparison to the lifespan, even like, okay, when you're in your 20s, you know, and 30s, or when you're in your teenage years, what's normal? What's normal, you know, in your 40s? And then, you know, what about, you know, when you're in your 50s? Um, so I think, you know, the symptoms that show up when we're at work, like fatigue, you know, pain, dog, certain mood changes, they impact our performance and our overall well-being. And yet I think we're really like conditioned to just let's push through, let's figure out how we can just keep going because this is kind of an inconvenience.

SPEAKER_00 7:04

Mm-hmm. Yeah, inconvenience and the stigma. Um, I mean, back to your original point. I think there's still a lot of stigma that that holds true with menstruation and menopause. Um, and we can we could have a whole other webinar and conversation about that um and how we break those, break that stigma in the workplace. But for right now, can you can you set a foundation for us? I want to walk through how menstrual health evolves over a woman's lifespan. And let me advance the slide here for you. Um let's look, let's dive in because I know that um this particular graph was really important for for you to speak to. So can you take us through and and what does it look like? What does menstrual health look like and how does it evolve over the woman's life at different life stages?

Menstrual Cycle Hormones Explained

SPEAKER_01 8:03

Yeah, I want to just take a like a just a moment. I want to take a moment to really take a look at this cycle right here, because I think this speaks to exactly what's happening, you know, in our bodies. And, you know, day one being the day that the first day of your period, the first 14 days of your cycle is considered the follicular phase. And that's the phase where you know you have a follicle that um starts to secrete estrogen, and that estrogen level starts to increase by day 14. You've produced a certain amount of estrogen for a certain amount of time, and that's what promotes ovulation. And so we look at ovulation happening around day 14. So that's when your estrogen peaks. And then once you've ovulated, your estrogen starts to fall and your progesterone starts to rise, and that's day 14 to 28 of your cycle. And um, and then again, you you you you have your period around, you know, day 28 and to day one. So it's a very um uh cyclical process when things are working normally. And uh I think it's important also to know that there are two parts of the brain, your hypothalamus is the first part, and that will send a message to your pituitary, your pituitary response to that message and sends a message to your ovary. And this is how this whole relationship works. And um, as you can see, you know, you have the hormone levels, your FSH and LH are um are what are produced by the hypothalamus. Um, and I'm sorry, GNRH is produced by the hypothalamus, the pituitary secretes FSH and LH, and FSH and LH act on the ovary, and the ovary produces estrogen and progesterone, and that kind of cycles um through this, what is considered the menstrual cycle. And then um just to answer your question about, you know, looking at menstrual cycle across the health span,

What’s Normal And What Isn’t

SPEAKER_01 10:04

right? Across of our health span. Um, you know, during your teenage years and your early 20s is, you know, when you consider that you experience what we call menarchy. And menarchy is when you have your first period. Um, so the first few years after menarchy, your cycles tend to be irregular. And this is really normal because that HPO axis, well, I said the hypothalamus, pituitary, and ovarian axis, needs time to mature. As that axis matures, things tend to normalize. During the teenage and 20-year cycle or period, what's not normal is severe pain. Bleeding, where you're soaking through a tab, a pad, or a tampon every hour for several hours. Something like those things need evaluation. So the earlier we identify these issues, the sooner we can determine whether or not there's any intervention that's needed. And then we tend to have better outcomes. So this is why it's important to really identify what is normal and what is not normal during this phase. And for those who are, you know, you know, during this time who end up on a birth control pill, it's important to understand that birth control pills can mask symptoms like, you know, PMDD, which we'll talk about a little bit more, or endometriosis. So I think it's really important to identify that you know yeah, I I appreciate that.

SPEAKER_00 11:43

And I'm wondering, um, this might be uh a good place to ask, are there um are there racial and ethnic disparities in menstrual health? Does this look different depending on race and ethnic background?

SPEAKER_01 12:00

So

Disparities And Underdiagnosed Conditions

SPEAKER_01 12:01

what I would say to how to answer that question, when we look at, you know, especially Black women, um, they're disproportionately affected by things like endometriosis, fibroids, um, you know, the diagnosis of PMDD, those kinds of things. And I think those tend to show up, you know, more in your late 20s and your 30s. So, you know, when we jump into that phase of the 20s and 30s, that's when we look at cycles being more predictable, right? And we know that things like stress, relationship and education demands or career demands, relationship changes, pregnancy postpartum, things like that can impact, you know, your cycle. But I think that is when we start to identify in your late 20s and 30s, we start to identify things like fibroids, endometriosis, thyroid issues, that's when they become prominent. And I think when we start to think about fibroids, black women are disproportionately affected, you know, by fibroids and endometriosis. And I think PMDD, PMS, you know, PMDD is really much more underdiagnosed in women of color. So it's important to know, okay, if PMDD maybe may show up during this time, fibroids may show up during this time. How do we know? How do we know if what we're going through and what we're experiencing is simply normal or could it be something else?

SPEAKER_00 13:38

Yeah, really important. Um, if we don't know what's normal, we don't know it that we're experiencing something that's abnormal and we should go seek help. So that makes sense. Um, I'm wondering if you can just take a brief minute here to help our listeners and our audience understand what PMDD is. And um I'm not sure that everyone is familiar with that. Hi

Sponsor: Natura AI

SPEAKER_00 14:03

everyone, I want to jump in here real quick to share a new AI health company that just launched called Natura AI, and I'm loving it. Natura is an AI wellness assistant built specifically to meet you where you are and help guide you through your natural health journey. Whether you're trying to make sense of symptoms, supplements, ingredients, cycle changes, cleaning products, or conflicting wellness advice online, Natura gives you a thoughtful place to start. They have a robust knowledge base of over 100,000 medical and wellness sources, and it's growing every day. Natura is also built with safety and privacy at the center, so your health questions and personal context stay personal to you. You can ask Natura about herbs, supplements, food, wellness routines, family health questions, or even products you're comparing in the grocery store file. It helps to understand what may be worth exploring, what the research says, and when something might need a clinician's inquiry. It's not a replacement for medical care, but it can be a really helpful support tool when you want to feel more informed and less overwhelmed. So, whether you're at the doctor's office and you want to suck an opinion, standing in the store, trying to choose between two products, or you're just trying to sort through all the noise around women's health, hormones cycles, and everyday wellness, Natura AI gives you a calmer, more personalized way to figure out your next step. You can check it out at my natura.ai. That's M-Y-N-A-T-U-R-A.ai. So try it yourself. Now back to the show.

PMS Vs PMDD And Mood Symptoms

SPEAKER_01 15:48

Yeah, so I think we've all heard about PMS, right? We all and and you know, PMS, PMDD, the main difference is how um the impact on your quality of life. So PMS, we think about mood swings, irritability, bloating, fatigue, breast tenderness, all these happening pretty much the week or two before your cycle occurs as a result of that rise in progesterone. PMDD are those same symptoms, but amplified and resulting in an impact in your quality of life, where your work is disrupted, your relationships are disrupted, and there is a clear impact on, you know, on your life, on your lifestyle. So it's very treatable, but I think it's important to know that PMDD and PMS are very different in their clinical diagnosis and one should not be swapped out for the other.

SPEAKER_00 16:49

Yeah. Thank you for that clarification. I think it's important, it's important to name that it's important to understand that while we're talking about menstrual health issues and challenges, what are some of the more common menstrual health issues that are misunderstood, dismissed, misdiagnosed, or maybe even just normalized?

SPEAKER_01 17:08

Yeah. So I think heavy, well, I know heavy bleeding is one of the things. And I see this because I get patients who shall end up in the emergency room, a blood count of five, whereas 12 is supposed to be normal. They can't breathe, they're lightheaded, they're dizzy, and they when we talk about their periods and how heavy they were, they think, oh, I just thought that this was normal. Right? So when you start soaking through a pad every hour or a tampon every hour for multiple hours, that is not normal. We start to think about could this be from a fibroid, a polyp, a clotting disorder, you know, or some hormonal shifts can result in that. So, you know, heavy bleeding is one that I think I see especially in black women, they just think, I just thought that this is how my body operated. And it's it's really important to identify that that is not normal. If you start bleeding for more than seven days and it lasts eight, nine, ten, twenty days, that is not normal. Um, another one, debilitating cramps. You know, it's one thing to be able to know that you have cramps with your period, but end up needing to take ibuprofen and they go away. Um, but pain that impacts your daily life and really requires much stronger pain medication, it keeps you at home from work or school, that really is not normal. And then I okay, go ahead. Yeah, go ahead. No, go ahead. You know, I think of things like severe mood changes, right? Like PMDD that we just talked about. You know, when it starts to really impact your ability to, you know, function at work, to be able to um or you know, attend school, that you know, five to eight percent of women are diagnosed with PMDD. So it's a real phenomenon. Um, but they tend to be misdiagnosed as, oh, it's anxiety or depression.

SPEAKER_00 19:08

Right.

SPEAKER_01 19:09

You know, so you know, and then and then let's say you're in your 40s, your cycles suddenly start to change significantly. They're shorter, they're longer, or they may be heavier or lighter. When you notice a change in pattern, that's something to start asking questions about because there could be that could signal something underlying going on in your body, and your our body tells us everything we need to know.

SPEAKER_00 19:35

So important. And I know we're gonna get to uh perimenopause, menopause, and and spend a little bit of time in that perimenopause conversation because there's so much that happens um at that point in our lives, especially with our menstrual cycles, as you just mentioned.

Myths About Pain Labs Perimenopause

SPEAKER_00 19:51

But before we move on, I'm wondering if we can do a little uh quick myth busting moment, if you will. And um if you can just kind of share with us maybe two or three things that you hear all the time that you wish people would stop believing. I think that might be important.

SPEAKER_01 20:09

Yeah. So, and it's so funny because I keep looking at you in the corner over here. If my eyes are looking in the corner, it's only because you know, I'm looking at April. She's not in the middle of my screen, she's up in the corner over there.

SPEAKER_00 20:23

It's okay because you know what? This is just this is real life, and this is um, this is the the reality of webinars and live webinars. I actually can't see you at all because I'm sharing my slides and my screen. So I'm looking at your lovely menstrual follicular face slide. So uh whoever, you know, wherever I'm looking, I'm just looking at a slide. I can't even see you. So go ahead. Yeah.

SPEAKER_01 20:53

So I'm and so can you just repeat the question again? Myth.

SPEAKER_00 20:56

Absolutely, myth busting. Um, myth myth, myth busting moment, if you will. I'm just wondering if you can share a couple of myths that you wish that people uh really we could clear it up that that shouldn't be.

SPEAKER_01 21:11

Yeah, so I think the there tends to be a myth that if you have normal labs and normal imaging studies, that you're fine. Like there's nothing wrong with you. And that's not true necessarily. It may take just a little bit more of a deeper dive into really like unraveling. Okay, can we look at the symptoms that you are having and where you are in your cycle? Is there a correlation between the elevations of estradiol or the elevation in progesterone and some of the ex uh the symptoms that you're experiencing? Normal labs is just the the the surface, but you know, it doesn't necessarily mean that you're fine. Painful periods are normal. That's another myth. You know. Like perimenopause is not a disease, right? That's another reason. You know, that like just because it's a natural transition doesn't mean that you have to suffer, right? Because I hear that all the time, you know, from from people like, oh, well, if it's just a natural transition, then you know, why do you have to to to to do anything about it? But no, you do not have to suffer. They're very, very safe options to help you manage your symptoms, and you deserve a conversation as to what aligns with where you are, what aligns with what you you know what what your priorities are. And I think you know, having those options is important. Um, another myth, um your you know, cycles, you know, where your um, you know, all mood symptoms are just anxiety. They're just anxiety that need to be treated with an antidepressant.

SPEAKER_00 23:00

We have a significant um percentage of women that are on antidepressants. Uh, what is that, what is that percentage? Can you recall right now, Dr. Donbow? I don't mean to put you on the spot, but a significant portion.

SPEAKER_01 23:13

I think it's um anywhere between 40 to 60 percent. That's what I thought.

SPEAKER_00 23:17

Yeah.

SPEAKER_01 23:18

And um, and I'm not saying antidepressants are bad. I'm not saying they're wrong. Um, I think as we talk more about like especially the perimenopausal transition, there's such a delicate balance between the role of estrogen and the neurotransmitters in our brain, like serotonin, dopamine, like there is such an it's it's very interconnected. And so estrogen tends to have a very stabilizing effect on neurotransmitters, you know, that are in our brain. So when estrogen starts to fluctuate, those neurotransmitters, those feel-good hormones, start to bounce around. And so, you know, we can add more, you know, to help with the volume of neurotransmitters, or we can try to stabilize right the the the fluctuations that are occurring. And I I want to also make sure that like there's no one right answer, but I think it involves really teasing apart what exactly, you know, how they how they can work together.

SPEAKER_00 24:21

Mm-hmm. Mm-hmm. Agree. That's why good care is um incredibly important. Can I come back to your um point about pain and painful periods are are just normal and we just need to deal with it? Um, I think there is definitely a myth that that's the case. Um, but I'm wondering how as a woman menstruating, how do I know what normal cramps are versus the painful period at the other end of the spectrum where I should go in and see someone?

SPEAKER_01 24:58

Right. So typically, like, you know, ibuprofen, which is an anti-inflammatory, what tends to happen when you have your period, a lot of like cytokines get released, and the anti-inflammatory um effects of you know ibuprofen tend to be, you know, what really help and do help with that kind of pain. If you find that that is not helping you and you are still in a significant amount of pain and you need more, you know, stronger medication, that is that is a signal that wait a minute, you know, something may not be right here. Um, so I think it's important to really listen to that. Like if you respond well, then you know, there is no issue. If you're not taking anything, I always say try at least, you know, uh 600 milligram ibuprofen so you don't get any relief with that. If you get relief, that's wonderful, right? If you don't get relief, then you know, we need to kind of talk about okay, what why is it that you're needing stronger medication?

SPEAKER_00 26:02

Right, right. You don't need to suffer. That's that's the point, right? And I think it comes back to quality of life. We talked about that with PMDD as well. If if it's impacting your quality of life and you're in that much pain, you don't need to suffer in that there are other solutions. So, okay.

Perimenopause Timeline And Early Signs

SPEAKER_00 26:17

Well, let's spend some some time here in the perimenopause uh stage, if you will, or conversation, because I think a lot of our audience is probably in this stage of life.

SPEAKER_01 26:28

Yeah.

SPEAKER_00 26:28

And it's something that we have difficulty navigating. So I'm wondering if you can spend a little bit of time here and talk to us about what perimenopause is, when it starts, and give us a little bit more information and how that affects our menstrual cycle.

SPEAKER_01 26:44

Yeah. So again, perimenopause is the transition leading up to menopause, and that can be anywhere from four years to 10 years, basing on based on your genetics, your ethnicity, you know, with black women it tending to be longer at the 10-year point, Hispanic women closer to the nine-year point, and you know, Caucasian women, you know, come in, you know, closer to seven years, but it can be anywhere from that four to 10 year, you know, uh range. It's a long time, by the way. And so it can start in your mid-30s, but more commonly we see it happening in your 40s, especially your mid-40s. And, you know, the average age of menopause in the United States is 51. So your periods don't have to stop, you know, by 51 for you to have begun perimenopause. And I think it's that's that's what we're starting to talk more about, is that, you know, your period you can still have regular periods and be in that, you know, state of perimenopause where you're having really bothersome symptoms. And I think it's well, I know I shouldn't say I think, I know it's really important to identify that the time of hormonal fluctuation in perimenopause can be worse. You your symptoms can be worse than postmenopause because hormones are going up and down and fluctuating, and it's a time of intense volatility. Mm-hmm. Mm-hmm.

SPEAKER_00 28:14

Like a roller coaster, right? Those we we compare it to a roller coaster with those hormones. Yeah.

SPEAKER_01 28:20

It's it's so volatile that the symptom burden during that time can be pretty significant.

SPEAKER_00 28:27

Yeah. And I think we are used to um that benchmark of periods, right? When we think of menopause and perimenopause, it comes back to our periods and our flow and our cycle. And are we missing those periods and are they sporadic? Um, and then when I'm when I have missed it for 12 consecutive months, then I'm in menopause and everything's okay. But that's not the case. Um, and there are what 34 plus, I'll use the just the plus symptoms that are associated with menopause. So women can experience more than just that change in period. Can you help us to understand what some of those other symptoms are in that perimenopause stage that we might be experiencing that might that might trigger, oh, wait a minute, I might be in this perimenopause stage.

SPEAKER_01 29:16

Yeah. So some of the early signs, and I'll start with you know, some of the earliest signs are sleep changes. You may notice subtle changes in your sleep where you are either having you're having difficulty falling asleep, you wake up in the middle of the night and you can't fall back asleep, or you start noticing that you wake up before your alarm clock goes up and you can't go back to sleep. So those sleep disruptions can start to occur in the beginning. Um, you can also start to notice some shifts in your mood. We talked about, you know, you know, irritability, anxiety, depression, those are all interconnected with, again, that stabilizing effect that estrogen has on those neurotransmitters in the brain. So, you know, that can occur. And again, brain fog, which is a lot of memory, issues where you can't remember the name of a word, you can't remember where you left your keys, you can't remember, you know, where you left your pair of shoes, um, you can't remember that you left your purse at the restaurant. So I I guess what I'm trying to say is, you know, these are you know, these can occur and a lot of times they can you can start thinking, oh my gosh, is it just that I'm getting old? Right. But there's actually something biochemically going on in your body. Um and that's why that cycle, you know, is it's really important to remember that that menstrual cycle, like when things are are are thrown off, your body really responds to the impact of that. Um, you know, the subtle changes in your cycle, like I mentioned, like, you know, you may notice that man, I was every 28 days, now every 21 days. That's a change for me. Or you may notice that, wow, I'm now every 35 days instead of every 28 days. Or you may notice again that my periods have just started gotten heavier. My, you know, the the late number of days I'm bleeding is longer, or it may be lighter. So many different changes that can occur, but it's you'll notice a baseline change. You could notice a baseline change in your periods. And I think you start noticing changes in your sex drive. Yeah. Vaginal dryness, you know, you just it's it's just harder to for you to get you know lubric lubricated during energy feel drier. Notice that you're having changes in your bladder function where you could hold your pee easily and get to the bathroom. But now it's like, whoa, I gotta go. Yeah. Notice you have to pee. If you don't get to a bathroom and you're you leak, or you may notice that you're having recurrent urinary tract infections. It's just the the muscle in your bladder either becomes weaker as a result of just that reduced amount of estrogen or the fluctuating, you know, estrogen has an impact on the tissue, and your bladder function is starts to change. These are all signs, you know, that you know, this, this, this, this could be perimenopause.

Movement Joy And Lifestyle Basics

SPEAKER_00 32:10

Yeah, and really good to know. What do you what do you wish that women knew before they entered the perimenopause stage? What's important for us to know going going into this, getting ready to enter, right?

SPEAKER_01 32:24

I would say like I would I would 100% say you are not broken because I I I had no idea and I thought I was broken. I was aging. I thought that this is what it meant to get old. And you know what? You have to adapt your environment to match that, right? You can't talk anymore because you're just so tired. Like there are treatable ways to navigate this transition, and it's a time that you really can embrace the shift versus resist the shift. So that's what I would tell, you know, every woman. And I would also tell every woman um, you know, start learning the things that you enjoy when it comes to moving your body, because your body now is something that's not just um an option, but optional, yeah. Yeah. What kinds of ways to move your body do you enjoy? And then just remembering that, you know, muscle is one of the most important organs during this stage because that's what's going to really help your metabolic health. So, you know, and and nutrition.

SPEAKER_00 33:35

Yeah, yeah. The it's the lifestyle changes that you're talking about, right? I mean, there's a lot of conversation about um hormone therapy, but really lifestyle is just as important as anything that we're we're we're taking, right, or or putting on our body. Um, and I love that you just brought up um movement, find what you like to do for movement, because I also think that there's a lot of pressure uh on women in that menopausal, post-menopausal stage and lift hard, lift heavy, right? Do your hip sit workout and it's like really move your body. What do you enjoy doing? Right. Yeah, yeah.

SPEAKER_01 34:15

And and and bring other people along with you, you know. Like I have this place that I love to hike, and so I just like now I'll send people pictures and they're like, oh my gosh, that's so pretty. I'd love to hike with you. Okay, let's do it. You know, let's figure out a day. Because I think, you know, it doesn't have to be um, you know, something that you navigate alone, and it can be fun, you know, to start doing it with other people. So I I think that's important. I mean, yeah, we see the standard. Yeah, yeah, yeah. And that's important. I don't want to dismiss that at all. Yeah. But I think like, let's just get back to basics, right? Joy, community, like those are equally important as okay, the lift heavy, right? We don't want to lift heavy at the expense of all the other things because I think that's where it can become detrimental to our mental health. Because then we look at something that seems unachievable if we don't, you know, do resistance exercise like four times a week or three times a week, you know, along with this and eating our protein, it becomes it becomes a standard that we feel like we won't ever meet up to. Achieve, right? I can't do it, right? Right. And and that's not what this is meant to be.

SPEAKER_00 35:28

It's a terrible feeling.

SPEAKER_01 35:30

Like this is life. Let's enjoy it, you know, and let's do the things that we know we can have goals, but you know, it it's not the end of the world if you don't get to that point, but you're doing something, you know, you're you're moving your body in some way.

SPEAKER_00 35:48

You're doing something, you're finding joy. Thank you for taking the pressure off all of us, Dr. Telpo. Um, you mentioned mental health. So

Hormones And Mental Health Link

SPEAKER_00 35:57

um I I want to ask the question um, it is there a correlation between menstrual health, hormone health, mental health? And if so, can you talk to us a little bit about that?

SPEAKER_01 36:12

Yes. So there is a definite direct correlation um between you know our menstrual health, our hormonal health, and our mental health. And um it's it's really um important that this is something we all understand because it can be very isolating if you do not know the connection, right? And I think I mentioned it before already, but like when you start to feel bad and you don't you start not to feel like yourself, you know, it's easy to question what is wrong with me. Like as women, I think. Right, right. You know, we tend to think, what is wrong with me? Why can't I, you know, like why why am I, you know, unhappy or why am I miserable or why do I just feel mad? You know, the things that used to bring me joy, you know, don't bring me joy anymore. And it is important, you know, especially in your 40s, to identify that like the estrogen and progesterone are deeply connected to the neurotransmitter systems in our brain. So, as I mentioned, serotonin, dopamine, GABA, those are all neurotransmitters that are in our brains. And when estrogen levels fluctuate, whether it's before or your cycle, postpartum, perimenopause, your mood, your cognition, your emotional regulation are all affected.

unknown 37:35

Yeah.

SPEAKER_01 37:36

So this is a biochemical issue, it's not a you're not good enough issue, or just get it together issue, or push yourself harder.

SPEAKER_00 37:47

You're going crazy, so just deal with it, right? Yeah, that's how we feel though, right? I mean, that is how we feel, and um, it's important to understand that um we're not going crazy. We're not going crazy. There is something happening um in our brain, in our body. Every part of our body is affected when our hormones are um, I went, I don't want to say out of balance because we don't really balance our hormones, but um when when they're varied, right? We move into those life stages.

SPEAKER_01 38:22

Yeah. And I think it's important to also identify, just as you said. So, for example, severe dry eye, right? Like who knew that that was something that came with perimenopause, right? I ended up in an emergency room, but that is something that I tell my patients, when we don't know, it can be very isolating, it can be depressing, it can be like that is another aspect, right, of the mood, the impact on your mood. Certain things that are changing in your body that you have no control of, or or little control, little control. Right now, now that you're when you're educated, you're like, oh, okay, this is what it is. There's a little more power that you have, there's a little bit more hope, there's a little bit more optimism that okay, this is just something that is normal. We can get to normalize that. And I think that in and of itself for our mood is huge.

SPEAKER_00 39:13

Yeah. And the education um helps us to advocate for ourselves. We know what questions to ask, right? I sit in this space and uh you talked about dry eyes. It just reminded me that um I have extremely dry eyes, and it didn't even, the connection wasn't even made for me who marinates in this every single day. And I fortunately had an eye doctor that's not my normal eye doctor that said, Hey, your eyes are dry, could be hormones. And we went into this whole conversation. I thought, oh my gosh, I finally have relief for my dry eyes. But again, I didn't know. Um, so I think the education is really important so that we can advocate for ourselves and we know how we know what questions to ask our physicians. Right. Have that conversation.

SPEAKER_01 40:00

And April, it's really important. And I want everybody to know that remember, these symptoms are happening all over our bodies, and there isn't one doctor necessarily who you go to who will put all the pistons. Everything. Yeah, yeah. Shuttled over here for this, shuttled over there for that, shuttled over here for this. And no, obviously, you know, the impact of the WHI on the on women's health. You know, we've taken a hit to, you know, being able to know more and educate women more. So now we're doing that. That's why it's important because your doctors may not necessarily put all the pieces together and realize, oh, all these different things are the results of one thing.

SPEAKER_00 40:45

That's right. We're learning, you're learning as a physician, everyone's learning and growing, right? We're in this together, and we're all learning. So yeah, thank you for that. I

Tracking Symptoms To Advocate Better

SPEAKER_00 40:57

want to um make sure that we leave everyone with practical steps, things that they can do to advocate for themselves. So if we have people that are listening, watching, that might find themselves in the peri-menopause stage or they're having challenges with their menstrual cycle, what are some things that they can do? What are some practical steps?

SPEAKER_01 41:20

I always tell patients to track your cycle over three months. Okay. Um, patterns become visible. Um, your period dates, your symptoms, are they happening in that first 14 days that we saw? Are they happening more pronounced in the 14 to 28 day, you know, part of your cycle? If you can read if you can track symptoms and cycle over three months, you can see patterns. And then the doctor who you talk to will see the patterns a lot more clearly. And um, being very specific and naming your symptoms is really important in terms of the way that whoever you see will respond. Because as doctors, we look for patterns. That's how we're to know, okay, if something's happening reoccurringly, there's obviously something underlying, and we can kind of shape, okay, and come up with a better diagnosis because it's your body, right? Yeah, we know it, we know our bodies, right? And we're just here trying to piece together what's going on with you. So really being able to have that clarity, you know, and seeing if there are patterns that are happening. Um, and then again, when I when instead of going in and saying I'm not sleeping well, I am waking up at 3 a.m. four times a week for two months. Be specific. Yeah. Be very specific because that is very different than oh, I'm just not sleeping well. You know what I mean? And so when a doctor hears that, they're like, Oh, okay, wow. They get to see not only the impact, you know, how often it's occurring and um how it's impacting the quality of your life.

SPEAKER_00 43:09

Yeah, it's so important. And I'm thinking about the the heavy periods and their regular periods and um how specific we can actually drill down and bring that information to our physician as well. I mean, you fill in the blank with the symptom, but just be specific. We tell people that all the time during our training sessions. And it's nice that you broke that down to give specific examples because I think sometimes when we say be specific, we don't understand what that means either.

SPEAKER_01 43:34

Yeah. I mean, I think from the doctor's end, right? Because I've been in cultural environments where cultural norms will be like, I can't sleep or I'm I'm not sleeping well, but it doesn't help me pinpoint where the exact problem is because that could mean anything.

SPEAKER_00 43:51

Right, right. And you know, I think sometimes we feel like um we're bothering the physician, like I don't know. To be a pain in the drain, I don't want to ask too many questions. I want to be nice. I don't want to take too much of their time. But really, what you're saying is please do.

SPEAKER_01 44:11

At the end of the day, what will happen is majority of the time that you're face to face with the doctor, they're going to be having to drill and dig. And majority of the time is going to be spent trying to get and pull out that information to you so that they can try to figure out okay, is there a pattern? Is there not a pattern? If you can't put together a pattern, they're just going to be like, oh, it's easier for them to be like, yeah, this may not even be a real problem. Right. Right. Can go with you know accelerating that process for them. The chances of you having more time to actually discuss the treatment options, right? You don't have more time to do that. Yeah. Um, because again, it's again, history gives us 80% of the diagnoses. We get it from just what you tell us.

unknown 45:01

Yeah.

SPEAKER_00 45:01

So it's a better practice, better outcome.

SPEAKER_01 45:03

So if you take a doctor like 15 minutes to pull out all that information, you're missing out on the opportunity for that time to be used to really be like, oh, let's talk about what we could actually do to improve. Yeah. Because this is what it looks like it could be. So a lot of times you're being like, hey, well, it could be this, it could be that. The doctor's like, well, let's just send you for tests. Let's try this. Yeah, let's right, right. But I think, yeah, it just it just really helps on the doctor's end to become down a little easier.

SPEAKER_00 45:38

Yeah. The education, educating yourself, knowing your body, understanding it, tracking, preparing for the doctor's visit will give you a better outcome. So um, there you go.

Telehealth Access And Building A Team

SPEAKER_00 45:49

For the for those that might not have access to in-person care, where can we get help? What do we do?

SPEAKER_01 45:58

So there's, I mean, I um particularly work for a company named Alloy, but there are a lot of telehealth platforms that um the beauty is that they provide access uh to women in remote areas who may not necessarily even have access to um a specialist for miles, you know, or may have to travel to a main city. And then when they do travel, they may have to wait like six months, you know, for appointment. So there are telehealth companies like Alloy that offer online virtual consults, and you know, you are able to be seen within a relatively short period of time. You know, there's a little bit more flexibility in terms of, you know, if you're on your lunch break, so you don't have to travel, you know, right.

SPEAKER_00 46:48

You don't have to take the time off work to see a physician, right?

SPEAKER_01 46:51

You don't have to necessarily take the time off because that that can be a barrier, especially for some women of color, right? It's like I've had to do this, I've had to like my I don't I can't get breaks, you know, at work. There are other issues that can be a barrier to getting the care that you need. So, you know, there are opportunities to be able to find somebody who can help you sooner and offer you solutions sooner than having to be seen.

SPEAKER_00 47:16

And oftentimes we don't need a vaginal exam, right? I mean, that's the question that we get all the time. Well, don't I need a vaginal exam if I'm going in to see a physician for? And sometimes that's necessary, but not all the time. Not ever, not every case, right?

SPEAKER_01 47:31

It really depends because again, if you have painful periods or you're having you know there's heavy bleeding, yeah, definitely need you know, an in-person evaluation. But if we're talking about, you know, perimenopause, POS, things where this can be it done in conjunction, you know, with your gynecologist or your PCP, there are specialists when it comes to polycystic ovarian syndrome, or even if you're having PM DD or you know, perimenopause, where they work alongside your so it's not exclusive, but alongside your doctor. So let's say you know, you you consult with one of these specialists, they come up with a treatment plan. A lot of times, you know, if there are any issues that occur, we're still having you go see your gynecologist or you know, your PCP. So it's not an either or, it's in connection.

SPEAKER_00 48:26

It's the whole team. Yeah, we say build your team, have your team, and it's a team of individuals that are helping. Yeah. Thank you for that. Yeah. Um, we

Resources And Where To Start

SPEAKER_00 48:35

are at the top of the hour. So we don't have time to take questions, but I'm wondering if anyone has additional questions, um, where they might be able to find you. We you're you work with AlloyHelp. Where can they find you?

SPEAKER_01 48:50

So um www.myalloy.com. Um, I also love to produce educational content, you know, for women in midlife. And I'm at dr dr.couldsi on Instagram and TikTok. And um yeah, and that's that's where I am at the moment.

SPEAKER_00 49:12

That's fantastic. And we have some that are watching this webinar, some that will be listening to it. So that is spelled K-U-D-Z-A-I, correct? Okay, I've got that. Yeah. Well, fantastic. This has been a great conversation. I wish that we actually had two hours because I have a lot more questions for you, but maybe we do uh a version two or take two. But thank you so much, Dr. Dombo, for being here and sharing your expertise with everyone. And happy menstrual hygiene day. Thanks for being here with me on this day.

SPEAKER_01 49:48

Thank you. It was my pleasure.

SPEAKER_00 49:50

Take good care. Bye-bye. Thank you for listening to the Medovia Menopause Podcast. If you enjoyed today's show, please give it a thumbs up, subscribe for future episodes, leave a review, and share this episode with a friend. Medovia is out to change the narrative. Learn more at Medovia.com. That's M I D O V I A.com.