Breast Intentions

The Role Of Ethnicity, Culture And Environment In Menopause

• Nadine & Cynthia • Season 2 • Episode 16

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Episode Summary

This episode features Dr. Martinez discussing menopause, its symptoms across different races and cultures, and the importance of tailored healthcare. Gain insights into how ethnicity influences menopause experiences and the need for more inclusive research.

Key Topics

- Race and ethnicity influence menopause symptoms and duration
- Cultural perceptions shape menopause experiences and openness
- Need for more inclusive research on menopause in diverse populations
- Hormone replacement therapy and its effects on brain health
- Lifestyle, diet, and environment impact menopause symptoms

Chapters

00:00 Introduction to Menopause and Its Importance
03:04 Cultural and Racial Differences in Menopause
05:57 Research Gaps and the Need for Inclusivity
08:50 Symptoms and Their Variations Across Populations
11:50 The Role of Environment and Lifestyle
15:03 Menopause Conversations in Different Communities
17:54 Stigma and Seeking Support
21:14 Healthcare Access and Its Impact
24:06 Stress and Socioeconomic Factors
26:52 Health Risks Associated with Menopause
30:10 Lifestyle Changes and Nutrition
32:59 Misconceptions About Menopause
35:52 The Future of Menopause Research
38:46 Empowering Women Through Education
42:05 Final Thoughts and Key Takeaways

Disclaimer

Breast Intentions is intended for informational and entertainment purposes only. The content shared on this podcast is not a substitute for professional medical advice, diagnosis, or treatment. Any views or opinions expressed by the hosts and guests are their own and do not necessarily reflect the views of any affiliated organizations. Always consult with a qualified healthcare provider for medical advice or concerns.

Resources & Mentions:

• Find Dr Martinez on Instagram (@rejuvenatebydrmartinez) 

• Follow us on Instagram and Facebook (@breastintentionspodcast ) 

Connect With Us: Have a topic or guest suggestion? Email us at breastintentionspodcast@gmail.com 

SPEAKER_01

The beauty in Cayman is that we have so many different cultures, so many different women with different backgrounds, so many different genetics and DNA. It is a topic that we are talking more about it and what it would be even more amazing if we start talking to a younger individual, younger women, so we have enough time because menopause is not the right here and then. Menopause is a metabolic and physiological changes that start from way earlier.

SPEAKER_04

Welcome to Breast Intentions, the podcast where we take off the bra of expectations and dive into honest, empowering conversations. We're your hosts, Snedine and Cynthia, two Canadian girls who swapped snow boots for flip-flops in the Cayman Islands. This is your space to feel seen, supported, and a little less alone. So grab a cup of coffee or a glass of champagne and get ready for your weekly handful of truth, wellness, and empowerment. Welcome back to Rest Intentions. Today we're exploring how ethnicity, culture, and environment shape the menopause experience. From attitudes toward aging and the impact of diet to symptoms, lifestyle, and access to care. It's a conversation that's rarely had, but incredibly important. And Dr. Martinez is here to help us unpack it.

SPEAKER_02

So on today's episode, we have Dr. Martinez. Welcome to the show.

SPEAKER_01

Thank you.

SPEAKER_02

Thank you for coming. And you're a doctor at HSA down here on the island. Um and from Cayman. Yes. As well. Um for all of our listeners. Um, actually, maybe I should even just say as well, like the topic of this podcast is something that we've been very interested in, and we've really been um, you know, trying to find someone to come on the episode and and talk with us about it, is all about menopause and how it shows up within different races and ethnicities. And um, so we're very excited to have you here. Um, but could you give our listeners a little bit of an intro on how you ended up going down, I guess maybe the route of being a menopause specialist, is that what you call it? Correct. Yeah.

SPEAKER_01

Well, first of all, thank you so much for having me here. Thank you so much for uh what you're doing, educating women about this amazing topic, which is menopause. Um, I think that menopause or the desire to uh educate women and my patients about menopause came from the fact that me as a woman experienced uh a diagnosis of uh depression when I was what I was going through was really menopause. Just on the basis of being misdiagnosed and underheard, I think that I say, you know what, I had to find the route and help myself so I can help others. So that's where it came my desire. So I work at the Health Services Authority, full-time internees work seven days a week, and I do my clinics, and I now have um asked HSA, please consider one week for Menopause Clinic because uh is there is not enough education out there for women about this. Um I try to balance my internal medicine, my own call, family life, and menopause.

SPEAKER_02

Yes, yeah, balancing it all. Yes.

SPEAKER_01

I am a general medical practitioner, internal medicine. I have a master's in hematology, a postgraduate diploma in geriatric medicine, and a menopause management from Essex University in the UK with a British menopause certification.

SPEAKER_02

Okay, okay. Well, I'm very very excited and looking forward to having this chat. So when it comes to women, all women are gonna go through menopause. It's gonna show up differently for everyone. Um but when it comes to uh a woman's race and her ethnicity and her culture and her environment, why do you think this conversation is so important right now?

SPEAKER_01

Well, first of all, what we have, the data that we have, it comes from one of the largest studies that it was conducted with the women's health uh initiative, this fan study, where uh it was a study uh around the world where what we know from this study is that based on race, uh black women there have more basal motor symptoms. They hit harder with those hot flashes, those night sweats. And there is a big uh understanding that those hot flashes are not only hot flashes, they have uh impact in their cardiovascular uh system and even with the onset of um uh mental status, uh alter mental status. Uh, from the data also that it was gathered. Um, unfortunately, this study was only done on white or Caucasian women, middle-aged class. So a lot of uh women were excluded from this study. But what recent data has shown is that Hispanic women they have more uh depressed mood, um more depressive symptoms, while uh more women of indigenous background, they are the ones that has less, they've been studied less. So not much data has been there, but what they believe is this is because of lack of education, lack of knowledge. So definitely race, ethnicity, and culture and the environment itself, they are things that we need to be aware and that we need to talk about.

SPEAKER_02

Right. And I don't think that it is talked about enough. Not at all. Even those studies, those studies really don't talk about how um you know, they'll say like this study was only this many people or this many people, but they don't break it down by race.

SPEAKER_01

No. It's very limited. It's very, and like I said, with this one study, uh, which is one of the biggest studies, um, there was like I said, on on middle-age, uh, middle class and uh Caucasian women. So there was a lot of exclusions. But recent data uh have pointed that Hispanic women, and maybe that's where we need to face uh the focus on new studies considering race by itself.

SPEAKER_02

Right, right. So you're saying for um for black women it's more of the Vesa motor symptoms, those hot flashes, those night sweats.

SPEAKER_01

Yes.

SPEAKER_02

I think I've also heard that their menopause lasts longer too.

SPEAKER_01

Yes, you are correct. Yeah.

SPEAKER_02

Yeah, I did hear that. Okay. And then also you said Hispanic women, indigenous women as well um do experience more heightened.

SPEAKER_01

More those those symptoms are are hidden because they are not so open, and that's where the culture comes in. Where culturally they're not uh like you know, open to talk about it, you shouldn't talk about it, or or that is just a natural process and you should deal with it.

SPEAKER_03

Right.

SPEAKER_01

So that's where the culture aspect comes into play.

SPEAKER_02

Wow. Um and I don't know if this this question is on there, but um, is there a lot more research now being done because they have realized this?

SPEAKER_01

Or currently there's no studies that they are being looked at done and they it is being proposed um on and every day there's more studies that come, but is they they're analyzing more the impact of the HRT uh and the cardiovascular effect of HRT, the neural. There was uh an amazing study. Uh again, it's not part of the uh podcast today, but there was an amazing study done where they analyzed the MRI of the brain MRI of um women who were going through menopause and those women who were starting on HRT before than those who were after, and they found that incident of the white matter uh on women before with HRT treatment, it was less, meaning that they had less onset of dementia or you know, confusion or depressed moods if you started at an early stage.

SPEAKER_02

Right, right. Are there certain symptoms, and we we may have covered some of this, but are there certain symptoms such as hot flashes, sleep disturbances, anxiety, mood changes, or waking that appear more commonly or more intensely in specific populations?

SPEAKER_01

Um so as we said, the hot flashes are more prevalent on uh um women of color, while sleep disturbances and anxiety are part of that spectrum more uh prevalent on Latin women or um Spanish cultures. Um so those mood changes and the weight. The weight gain uh is a is a topic by itself. And I think that is a topic right now that is gaining a lot of interest among even perimenopause women, that they start to experience these hormonal changes and they can understand why am I gaining so much weight if I'm just eating little. But then the physiology itself, right there, because now they have realized that the hormonal changes does not start doing menopause. Right. This hormonal changes starts from even your 35. So that's where we have to try to educate our patients, even our daughters. I said, listen, you need to be aware of what you know how we eat and what we eat. So definitely there are uh changes that they are being studied where weight gain affects uh women overall. And that has to see also with their lifestyle, the lifestyle choices and the genetics.

SPEAKER_02

Are there differences in the average age of women in menopause amongst different racial or ethnic groups?

SPEAKER_01

So what we know uh from the data is that the average onset of menopause is between 45 to 55, with a mid mean age of a median age about 51. However, we can see that the onset of menopause now starts at an early and you have genetic factors where that's where you have that conversation with your mom. Hey mom, did you have these symptoms earlier? What symptoms were you having? Uh, because that's going to determine, hey mom, like you know, how long or when did I have my first period? Because that will mark how soon would you have those menopausal symptoms. So definitely um there's differences on the onset among the differential um racial and ethnicity background.

SPEAKER_02

Okay.

SPEAKER_01

And you don't know though where like what ethnicities are like later on, or and again, there is not enough data uh about those, and that's when we started as a that is what is being proposed to look more in depth of the uh ethnicity. But that big study from Swan, what we know is that women of color are hidden harder. Women of color they have more symptoms uh than when compared to. But the genetics and the lifestyle plays a significant role on how soon or how late you're gonna have your period.

SPEAKER_02

So then I guess um the environmental side is quite big because of like what we're being exposed to earlier on and stuff like that.

SPEAKER_01

So we also know that not only the environment but the your diet. So for example, Asian women, Chinese and Japanese women, they have less symptoms uh than white women or women of color. Why? So it is being hypothesized that uh Chinese or Japanese is because their diet, they have more soy-based uh kind of day. Yeah, so they have less symptoms, but also we don't know if this is confounding factors, but there are cultural-wise, it's like okay, it is menopause, and we accept it.

SPEAKER_04

Yeah, it's a part, it's sort of revered a little bit, even in the in that culture, versus maybe a Caucasian who say it like it's no, no, it's the worst thing ever. You don't want to go through menopause.

SPEAKER_02

Yeah.

SPEAKER_04

Whereas it's looked at sort of a rite of passage, and uh you get wiser as you get welcome and go through menopause. Think about that in the end.

SPEAKER_01

Because in their culture, uh menopause for in um some cultures, you think that menopause is the end of life. Yeah, it's like the end of your reproductive life is like, okay, this is it, there's nothing wild for them. The older you get, the wiser you are. You claim status in society, you have uh conquered so much, you have so you are seen as a someone to look at. Well, in other societies, okay, you know, you don't you've been there, you've done that, and you are replaced.

SPEAKER_02

Right. Yeah. So it's very cultural.

SPEAKER_01

It is, it is. It is very cool.

SPEAKER_04

And there, yeah, there are studies to s to prove that this is impacting.

SPEAKER_01

It is impacting, correct.

SPEAKER_02

Yeah.

SPEAKER_04

That's interesting.

SPEAKER_02

Well, I guess that's just the answer is number five for me.

SPEAKER_04

But I also um I think I had read, I don't know if this is true, that women of color do start menopause or go into menopause earlier.

SPEAKER_01

So again, once it it plays a role where genetics. So if your mom had an early onset of menopause, it is likely that you are going to. And this comes in uh into play also because women of color they have more um hormonal dysregulation, they suffer more from uh uterine fibroids, uh, they have more hormonal imbalances, PCOS is more prevalent uh on women of color. So there are so many factors that play into a role, but the data indeed shows that women of color they have an early onset of menopause, the symptoms are hitting harder. But if you put that again in the context with cultural beliefs, one for a woman to of color that uh hit menopause, it's like okay, this is the end of life basically.

SPEAKER_04

So it all goes together.

SPEAKER_01

Yes?

SPEAKER_02

Wow. Okay. Are there any other uh cultures that you know of that women experience menopause differently that you can think of?

SPEAKER_01

So we spoke about the black women or women of color, we spoke about women, women uh Caucasian women, uh, we spoke about Asian, uh, less about the indigenous uh women. Yeah. Uh there are no studies out there on indigenous women because of like getting to them is almost impossible. They don't have the knowledge on how to process the information given to them. So for them, menopause is like, what is it? It's another phase of life. And I find it myself quite interesting. Um my father is an indigenous man, where um my grandmother is like, I just for me was used to see her fanning herself, but you know, or sweating, but it was normal. I never had her or heard her like, you know, uh talking about it. Um so for the indigenous women uh who have not been studied, I know that the impact is significant, but they again they don't talk about it. It's just part part of the acceptance that it is what it is.

SPEAKER_02

Wow, okay. Have you noticed that menopause is discussed more openly in some communities more than others?

SPEAKER_01

So um in Cayman, I find that the topic is being more widely discussed. It is. Um and thank you for this. Honestly, um there have been topics in conversations in the table. Yeah, you go for coffee, and you know, some women share the experiences. So we're talking more about it. And the beauty in Cayman is that we have so many different cultures, so many different women with different backgrounds, so many different genetics and DNA. So it is a topic that we are talking more about it. And what it would be even more amazing if we start talking to uh younger uh uh individual, younger women, so we have enough time because menopause is not the right here and then. Menopause is a metabolic and physiological changes that start from way earlier. So, yes, uh, I see that and I notice that menopause is more not only discussed but more openly talk as a topic in conversations about men. You will be surprised when I do presentations, the uh individuals with more questions are men.

SPEAKER_04

Which that's great. Yeah, yeah.

SPEAKER_01

Yeah.

SPEAKER_04

Because it's not like we've said this before on podcasts, it's not just a woman thing.

SPEAKER_00

Yeah.

SPEAKER_04

Because the women are the ones who are actually going through menopause, but the men in their lives are a part of it as well.

SPEAKER_02

Trickle down effect, kids, all of that kind of thing.

SPEAKER_01

And as you know, maybe from Oprah uh uh program where 60% of divorce uh occurs during the menopause, and because it's because men do not understand their wife and what they're going through, and women don't have the patience to put up with them.

SPEAKER_04

Right. Yep. Yep, no longer want like have the patience and no longer are going have that facade or have the ability to do that.

SPEAKER_02

I think we said a while back, many episodes back, that like HRT is saving a lot of marriages.

SPEAKER_01

Yes, yeah. Correct.

SPEAKER_02

For sure it is. Um, how do stigma or cultural expectations impact whether women seek support, speak openly about symptoms, or even recognize they're entering menopause?

SPEAKER_01

So again, the cultural expectations and the stigma comes with knowledge. The more uh uh women are prepared, the more that women are thought, they are more openly um ready to talk about it and to even seek treatment. But women who didn't had the preparation and they were not aware of what menopause was, uh, or it is, they are less likely to seek help. I can tell you from my own personal experience as a female uh facing the age, when when menopause hit me, I was not sure what it was because it was so much around me. And it wasn't it was the outside, my daughter who said, Mom, you need help. So when she said those words to me, it was it resonated in my head, and it's like, you know, I need help. I need help. I never knew that there could be something wrong with me until I realized that everything in my life was just falling apart. So the stigma and cultural expectations indeed impact. I as a woman, as a mixed, and right now you can't really say Caucasian, indigenous, black, we are such a mixed, we are so interracial, we are so intercultural that you can't really pinpoint at one um one person that you are Caucasian, you are of color.

SPEAKER_02

Right, fair enough. Um, in your practice, do you notice certain groups of women being less likely to seek medical ad medical care or advocate for themselves during this stage of life?

SPEAKER_01

I couldn't wait for this question to come. Yeah. Because in my practice, which has been in the past two years, um you see women now, I'm seeing women that they are past age of 60 coming to seek for help because they're like, I saw your video and you know, I have all the symptoms you talk about. Would this treatment be um I get even goosebumps? Uh would this be this treatment be uh good for me? And there's there's of course this treatment is for everyone, but you have to individualize because one size does not fit all. And this treatment must be individualized for everyone. So uh there is increase on women uh beyond the age of 60 that they are seeking help. I noticed that there are more women of color coming to uh trying to ask for help. It's like, okay, uh I have all the symptoms that I heard about related to menopause. So so yes, but this also could be because the access to healthcare. So while I work in the public system, I women who have access to the healthcare system public, now it's like, okay, I have access, I want to use it. But what about those women uh that are on WordPress minor basic plan that they can't have access to healthcare? So they they sit there, they embrace the symptoms, and not only the symptoms, but the implication that menopause has cardiovascularly, bone health, and even with our genitor upsis uh syndrome that most women are not open to talk about because of cultural beliefs.

SPEAKER_02

Right. What about internationally? Because uh we also have a lot of listeners um internationally outside of the island as well.

SPEAKER_01

So what I can tell you from my colleagues that works outside um and uh in the UK and in the US, there has been a great significant impact on their patients seeking for help more like in the UK, they have had a broad impact. And again, we've seen that those who are one myth of menopause is that people think that menopause uh comes and it goes. Like, oh, I I passed that. No, no, no, no. Once you enter menopause, you will be on menopause until the day you die, but that the symptoms could be periodically unless for different reasons, but they're seeing or they observe. That women beyond the age of 60 are seeking for help because they have endured those symptoms for let's say 10 years. And okay, there's help. So I need to get, and you know, I need to get the help.

SPEAKER_02

Well, and I think there's more conversation. And again, this is something that we talked about a long time ago. Um, but there's a lot more conversation because social media is around and you know, you can access the information a lot more. Um and one side of it though is like, what do you believe? And what are people telling you, and like all of this conflicting information and and all of that kind of stuff. It can be overwhelming for sure. It can. Um, and I think one of the positives from it though is a conversation is happening. Yeah.

SPEAKER_00

Yes.

SPEAKER_02

And it's just now where do you go? I don't want to say who do you believe, but like how can you be educated more on it? And that's part of the reason for why we do this podcast is like really to help kind of help people understand not just menopause itself, but the peripheral. Yes. So it's like we just did a podcast this morning on eyes and um pelvic health and um the vulva and yeah, yeah, yeah. Yeah, what's that? The brain, all the things. Yeah, the brain, yeah, yeah.

SPEAKER_01

So what the social media puts out there, what I will say to the listeners is that you need to make sure that the resources um or those who are um talking about menopause, they are clinicians like you know, in China now, you will be uh bang or penalized if you are talking about something and you are not a physician, if you do not have etc. So uh and and I think that that it is important because not only your experience, um, me as a female, me as a woman going through menopause, and me as a doctor, um I know that the topic that I will be talking about, it is it has validity, it has the evidence and the medical support. Um, and I see sometimes during TikTok it's like loaded with so much information. Some people will be against HRT, and that comes from the 2000 Women's Health Initiative study where it's like hormones is the worst. So it's to try to break that uh how would you call to break that fear that you know you shouldn't be afraid of hormones, but you should be afraid of the impact of not having hormones.

SPEAKER_04

Right. Yeah. It's probably I would say why this is a guess that a lot of women in their 60s are now asking for support and seeking support because 20 years ago when this study came out, they were part of the group that was like, no, it's it's bad. Don't worry about it. And they were in the depths of that at that point. And so they've avoided it or not been a part of it, and now they're like, wait a minute, can this actually help me?

SPEAKER_01

Yeah, and you're so right. So bear in mind those women who are 60 plus, there were 40 who were just entering menopause, so they have been suffering for 20 years, for two decades, with symptoms that can be so debilitating.

SPEAKER_04

Yeah. Sad. It is sad.

SPEAKER_01

It is sad.

SPEAKER_04

Okay, so we know that stress plays a major role in overall health. How do stress, socioeconomic status, and access to health care influence menopause outcomes across the different populations?

SPEAKER_01

All right, so let's break down this question in three. So, how does stress um affect the or influence the outcome? So we know that stress is gonna stimulate your hypopituitary thalamic axis. What is that? That's basically everybody talks about it, cortisol. So it's going to increase your cortisol levels in your body, and this cortisol is gonna call the other hormones, the counter-regulatory hormones. Hey, insulin, come here, I need some help. Um, hey, insulin growth factors, come here, I need some help. Um, so with the uh stress, your cortisol and the other counter-regulatory hormones, they're going to start impacting your body, your mental, and your entire body health. I get patients that they come to the clinics. Can I get a cortisol levels? We don't look at cortisol levels. We know that physiologically your cortisol levels are gonna go through the roof. And if I look and I find that your cortisol levels are high, then what are we gonna do about it? Yeah. So um now the other one is to socioeconomical status. So it's going to play a major role because access to healthcare versus no access to healthcare. And that is not only in Cayman. Access to healthcare is so limited. I think that healthcare is a luxury. And not only here, but anywhere. And that limited access to healthcare is going to have an impact on the uh outcome of how women are going to feel.

SPEAKER_04

That is, yeah, yeah, for sure. It's unfortunate it's a luxury. It's extremely unfortunate, but that's that is the world we live in right now.

SPEAKER_01

Exactly. So, for example, you have a chic plan that um allows you to see the doctor but can't cover the prescription. So it's like, what you're gonna do? And if that plan only covers you for a certain amount, what happened in the event of an emergency? Right. So it becomes to really what the needs and your wants. And that is so hard for you know, I need it um and I want it. So some women you see that is gonna impact the overall healthcare of you know seeking women for um alternative treatments for menopause.

SPEAKER_04

Right. Yeah, for sure. Are women of certain ethnic backgrounds at greater risk for conditions connected to menopause, such as osteoporosis, cardiovascular disease, sleep disorders, or metabolic issues?

SPEAKER_01

Okay. So uh we can break down also this question. So definitely there are ethnic backgrounds that can predispose. So, for example, we know that uh women of color and Hispanic women are more prone to cardiovascular uh disease. When I say cardiovascular, we know that during menopause increases our cardiovascular risk for um heart attacks and for strokes. And that's because all this um estrogen decline that is going to alter our lipid profile and etc. And the accumulation of visceral fat that women say, Oh, I'm doing everything and just, you know, I'm gaining weight right here. So black women and Hispanic women are more prevalent to have increased or higher risk of cardiovascular disease, and so the diet. Why we see that women with low vitamin D are more at risk for osteoporosis. So, where do we see uh the vitamin D deficiency on countries where sunlight is, you know, is the best source of vitamin D. So why Caucasian women who, Canada, the UK, uh they have less exposure to vitamin D, so they are more likely to uh develop osteoporosis. And the opposite occurs to women of color, because they have more uh increased bone density, so therefore they are less likely to have um osteoporotic or osteopenia. So that is quite interesting. That is interesting, and I think that if we, as clinicians, uh in the context of looking as a our patient as a whole, uh not only because of that, and that's another different topic itself, is the time that we are allocated to talk to during the clinic, it's like, oh, I come to talk about menopause, it's like okay. But how I how I bring it down is that I there's numerous menopause questionnaire that you find online. So NewSon's has a very good questionnaire, comprehensive, and based on that you have mild, moderate, or severe symptoms. If you have mild system symptoms, you do not need systemic therapy but localized therapy. If you have moderate to severe symptoms, so with moderate symptoms, you start to with the lowest dose of estrogen, and it's gonna depend if you have a womb or not. If you have severe symptoms, you have you start with a middle to higher dose of your um therapy and you implement complementary alternative medicine to the direct treatment that the woman might have. For example, you have uh menopause women with severe symptoms are having a uh musculoskeletal pain related of menopause. That's when you want to integrate your uh complementary as um acupuncture, massage, uh pressotherapy or lymphatic therapy. Or if you have a woman with uh systemic symptoms that they are severe and genital urinary syndrome, then then you can combine the systemic therapy with the localized HRT with uh testosterone. So you just again you have to individualize that approach to each woman based on uh validated questionnaires that they are available for us.

SPEAKER_04

Is that a way that a woman could maybe because if you if you're going to the doctor and there is limited time for the appointment, is that a way that they could maybe come prepared is to do some of these questionnaires online before they go to the doctor?

SPEAKER_01

That would be ideal. But you see, for example, in my practice, uh a patient comes and and they come with a list. I'm kidding you not. Yeah, because they have lived with this for so long, and now that with your help and with my help and the help of everyone, they are more aware that I've been diagnosed with fibromyalgia for so long when in reality I didn't have fibromyalgia. I had a hormonal imbalance. And you she had there are so many questions that they are all related to the same. And unfortunately, the time that we are allocated is not enough. So maybe we can start, or what I'm starting to do is to break those uh uh sessions into segments. Like when you go to the psychologist, you okay, we're gonna what what's you know happening today. So you break that session into what is happening today, what is battering you today, knowing that you have uh that knowing that you are menopausal and those symptoms are gonna fluctuate, you're gonna variate, it's gonna change. Yeah, some some days you have the shoulders, another day you have the plantafascia, another day you have the back pain, another day you woke up and you're very emotional. You just cry for no reason. Another day your husband, you know, chewing is annoying.

SPEAKER_04

Right. Yeah. Uh we talked about this a little bit, but maybe we could go in a little more detail about how lifestyle habits, nutrition, or traditional cultural practice influence how women navigate menopause symptoms and overall well-being.

SPEAKER_01

So, what we know is that you have a Mediterranean diet, for example. The Mediterranean diet is excellent for because it confer anti-inflammatory properties. So the Mediterranean diet is rich in soy, is it in and this soy is what the Asians use in their diet to help them and uh regulate the estrogen, because some of the estrogen comes from soy, those bioidentical hormones. Um the lifestyle exercise, we know with data that exercise, continuous exercise, and according to the WHO, this is a question I ask my patients. And so, do you exercise? Yes. What do you do? I play pickleball. Okay, uh, how often do you play pickleball? On weekends. So that is not exercise, that is a physical activity. So exercise by definition is 45 minutes at the time, five days a week, of a continuous make-it-be swimming. I say even dancing. You play your music and dance for 45 minutes, spinning, walking, cycling, swimming, anything as such. So the lifestyle is going to help us regulate our hormones, it's gonna help us regulate that hypopituitary thalamic axis, it's gonna load on our cortisol levels and is gonna have an impact in how our body uh feels, reduces the stress, um, and it's gonna help us to regulate our metabolism, has less inflammation, and feel good overall. Um, then the cultural practice. Um, in this, there's not much studies in terms of cultures, but I can tell you from the readings that I go around is that, for example, women in the um Asian countries, um, their diet is so clean, is so lean, and um maybe implementing sort of changes into the lifestyle of uh women, not menopause, but women overall, um, will start, you know, make the changes of the symptoms and improve their well-being and the quality of life.

SPEAKER_02

So, what about even a Caribbean culture in food?

SPEAKER_01

What are we gonna do? That's so I tell the patients when I go, because I go through comprehensive. So tell me about your diet. What is breakfast? Oh, I don't have breakfast. That is the worst thing that a menopausal, perimenopausal woman can do. That fasting can work for someone who's 20 or even early 30s, but that uh intermittent fasting does not work for us. And why? Because over cortisol is released between 6 in the morning to 8 o'clock in the morning. That's when your cortisol level shoots. So when you wake up, you already come from a prolonged fasting period, and then you skip breakfast. Your body is gonna hold on to whatever he has for their life. So I encourage women not to do any uh prolonged fasting. And what is lunch? Oh well, most of the people here order from restaurants. So I um do a little sketch of a plate. So tell me, this is 50% of your plate. How is the food distribution? Oh well, 50% is rice, 30% is the veggie, and 20% is the protein, and that is the worst thing. So the food plate distribution should be 50% of your protein. That other 50 you split it in 2030, that 30% should be your animal your protein, vegetable protein, and the other 20% should be your carbohydrates, but not all simple. That's when your chickpeas, your beans, your sweet potato should come into place. So it's really hard, and that's where uh we have to make culturally uh women be aware that that's one of the biggest um problems that we have to face from a cultural point of view of how they eat. And again, it comes from resources because eating healthy here is more expensive than environment resources.

SPEAKER_04

Well, and it is a part of the culture, right? Like it's uh family meal time and sharing these these specific meals that that is a part of a part of the culture. So that's difficult. I mean, I guess you can still incorporate it in some ways, not just maybe every single meal, I suppose.

SPEAKER_01

Correct?

SPEAKER_04

Yeah, because we don't want to take that away.

SPEAKER_01

No, no, but again, it comes to that distribution uh uh for the family. And when you ask them what is the first thing that they go at that they eat is what is the rice. Yeah, so it is a cultural and I think that more efforts are to be done, even from the school. I don't know if you had seen the meals that the kids get at the school.

SPEAKER_02

Oh, I can't get some. Does he? Yeah, he hates them. Oh yeah, yes.

SPEAKER_03

Yeah, it is.

SPEAKER_02

Yeah. I know. It's a whole other topic on that one.

unknown

Yeah.

SPEAKER_04

Uh what are some of the biggest misconceptions or myths about menopause that you encounter within the different cultural communities?

SPEAKER_01

So I have my own social media platform, so I do a lot of education on uh my TikTok. And one of those are the five biggest myths about menopause. So I'm on my fourth. So the first one is that women believe that menopause is just uh the end of uh a woman's uh life, basically. When uh what menopause just marks is the end of the cessation of your periods, and is uh it's a transition. So try to break that myth that is the end. It actually for some in some cultures is like you are viewed as the woman with more experience, you are viewed with the woman with more uh accomplishments, you are viewed. So we have to try to break that myth that I see is very applicable here because after you reach menopause, it's like, oh, you're just you're getting old. You know, they think that my me finding myself, oh you're just getting old. I'm getting old, yes, but I'm wiser. You know, I have acquired more experience. Um, so that's one. Uh two, the myth is that um menopause are only hot flashes. No. Menopause is beyond hot flashes. Uh, as I said uh uh earlier, uh culturally and ethnic-wise, Hispanic women, which I'm half and a half, my father is Colombian. So I think that uh that uh Latin part it had affected me uh emotionally uh with depressed moods, um, mood swings and etc. Um so the myth that hot flashes is menopause, no. There are over 60 symptoms that they are related with menopause, and women think that menopause is only hot flashes. Yeah. Another myth uh and women don't tend to talk about, uh, and even in clinic, it's like don't say much, is the decrease in libido, where you know women think that that decrease in libido is like, okay, I'm done. But it is important to understand that um sexual health is part of menopause, because if it's not, we're gonna have a lot of atrophic changes, a lot of vulgar changes that we will have to deal with as they go as we go along. So we don't have to accept that decreased libido is part of menopause. So those are some of the myths that is really hard, and again, culturally here, because women are not open to talk about it. Right.

SPEAKER_04

Yeah. Are there still significant gaps in menopause research when it comes to women of color and underrepresented populations?

SPEAKER_01

So we talked about this earlier. Uh the swang study studies more, and you find that more studies done on menopause are more like Caucasian women, uh, living uh women of colors, uh, living Latin women, and more important, so the minority of the women, the indigenous, and the indigenous women represent still a minority, but they have we don't know yet how uh they face the changes in menopause. We don't know, and the access to them is very also limited. So definitely there is significant gaps as how menopause uh research um and the menopause symptoms across the different uh ethnicity uh groups, and that's something that every time we go to conference and every time we do uh attend presentations, that is a proposed, but up until now there is nothing that is being really ready to be published.

SPEAKER_04

What can healthcare providers do better to ensure women of all backgrounds feel heard, supported, and properly educated during menopause?

SPEAKER_01

Well, I think that uh the more that we talk about it, the better it is. The more that we do not generalize, the better it is. The more that we uh tell women that uh it is okay to talk about it, uh it will be okay. So as a healthcare provider, uh I can speak for myself, but I will want my colleagues to join me in the efforts to not necessarily normalize menopause, but to make it a topic where um we are being uh told that we have to screen for depression across the board. So one question as part of my approach, are you depressed? And we have even intake forms that we have to do. So I will really hope that the system implements an intake form that goes through uh menopausal symptoms so we can really uh address it and add it as a one of the uh symptoms or signs or diagnosis and how we're gonna manage it. Rather than have or wait for the patients to come to us, we initiate this conversation.

SPEAKER_04

Earlier too, because I think a lot of us um we're in the middle of it and we're like, oh crap. Yes, yes, what is happening now? And so we're then trying to you know get our head above water and educate ourselves in the middle of it. But I can't imagine how things could have been differently if you know I was learned about this when I was 30 or 35, even, um, which is potentially when some of these symptoms actually started.

SPEAKER_01

So I have a 21-year-old, and for the past two years that I started to create awareness about menopause, uh, my daughter says to me, Boy, I'm not looking forward to menopause. And I'm trying to make her understand that this is something you should be looking forward with knowledge and understanding and acceptance, and that you need to seek help when help is due. You don't have to wait.

SPEAKER_04

Well, and it's not hopefully it's not like that. Like I I'm not looking forward to this. This sounds awful. Like that. We hope that the you know podcasts like ours or other things out there is creating that education and empowerment so that they can feel more ready to go through it.

SPEAKER_02

Well, and also know that there's so many things out there that can that can help like HRT. Like I can't even imagine, like, even just uh about myself. Where I probably would be if I wasn't if I wasn't using it. And um I was I was giving a menopause presentation last week and um I was just using myself as an example. And when I was it was either I think it was my early 40s and I was having a lot of anxiety. And so I started going for therapy. And I'm like, oh okay, well, maybe I'll just book my therapy sessions like once every three weeks or whatever it was. But it all of my therapy sessions landed on seven to ten days before my period. So I would go into my my therapy session um feeling like the world was gonna end, and obviously the anxiety was like kind of at its its highest. And then a week later, I felt like amazing. And I was like, I'm fine, this is great. And then all of a sudden, after I don't know how many sessions, I was like, I think I need to get my hormones checked, basically. Yes. And then sure enough, got my hormones checked and um had a hormonal imbalance and you know, and then took care of that. Not saying at all that um therapy is is not needed, but even with balancing out the hormones, the highs and the lows leading up to that were so much better. And I could have easily just kept on going and then just having this massive roller coaster of these ups and downs. Um, so you know, just kind of going back to the HRT, even for myself, it's it's made a world of a difference.

SPEAKER_01

I can tell you there was a paper that it was published uh about menopause and the mood uh and the depressed symptoms associated with it, which we know is because of the dopamine energy pathway with that decrease on that estrogen. What this study interestly shows, and for me it was like, wow, now I understand. Women like us who experience uh those anxiety, depressed mood, and all the um changes uh are due to the past that the fact that we had some traumatic event in our life. So we managed to put them in a little box. And when our estrogen declines, it's like for uh whatever reason that key opened that Pandora box again. So that's when when you start the HRT, you kinda quisen and are you open to deal with them in a better way.

SPEAKER_04

Alright, if there's one message you want every woman, regardless of race, ethnicity, or culture, to hear about menopause, what would it be?

SPEAKER_01

One message, I have several, but what is more important, I think that uh women need to understand that what's one size does not fits all. What is good for me is not good for you or you. Um that we need to be able to have this discussion uh in a table with our husband, with our children, um, with everyone, so we can create more awareness and being able to um deal with it in a better way so it can improve not only our quality of life but the quality of life of those who are around us who also get impacted because of menopause.

SPEAKER_02

Right.

SPEAKER_03

Yeah.

SPEAKER_02

And I think going into this podcast, uh my mind was very much set on um like how menopause shows up in different uh races. Racist ethics. Yeah, and but also the um the cultural and the environment environmental, I think. Um, and how all of that comes together. So it's not it's not um linear.

SPEAKER_04

Exactly. And nothing to do with menopause really is.

SPEAKER_01

No, no, yeah, that's because everyone has a different DNA, everyone uh has a different makeup, everybody has a like here with the summer, we are going to suffer with the heat, uh, on top of that with the hot flashes, but a woman who's living in a cool country will not be impacted as much as I would be as as how we will be.

SPEAKER_02

Right. Or even um different socioeconomics. Economics, yeah, for sure. Huge in terms of what you have access to, healthcare, what you have access to buy for food, um shelter, community, family, childcare, so you can go exercise.

SPEAKER_04

Do you have why are you working 12 hour days? Are you yeah, it's yeah, so all interconnected. It is.

SPEAKER_02

Wow.

SPEAKER_04

Well, this was great.

SPEAKER_02

Yeah. If um if any of our listeners do want to get in contact with you, how do they get in contact with you?

SPEAKER_01

Well, uh the Health Services Authority, uh, they can reach the 949-8600. Um, I am very uh much into my social media, so they message me a lot. Um, and I respond to the messages when I, you know, as soon as I can because I don't really want to see women suffering the way I did. Yeah.

SPEAKER_02

And what's your social media?

SPEAKER_01

I um on TikTok as Dr. Martinez. Yeah, simply, yeah.

SPEAKER_02

Instagram.

SPEAKER_01

Dr. Martinez, uh, menopause. Um I think that's it. Yeah, Dr. Martinez. Easy to find, yeah. Okay, great. There are two Dr. Martinez on Island. So one is female, the other one is the male. So I'm the female.

SPEAKER_02

Thanks for sorting that out. Well, thank you very much. We really appreciate it. Thank you. Thank you.

SPEAKER_01

Thank you so much for having me. Yes, really grateful.

unknown

Of course.

SPEAKER_01

Thank you.

SPEAKER_04

Thanks for joining us on Press Intentions. We hope you felt seen, supported, and maybe had a few laughs along the way. Don't forget to share, subscribe, rate, and review us. Your support keeps the conversation alive. Follow us on social media for more insights, behind-the-scenes fun, and updates on future episodes. Got a topic you want us to dive into? We'd love to hear from you. Remember, life's too short for bad bras, toxic relationships, and kale you don't actually like. So until next time, stay bold and keep your best intentions exactly where they belong. Front and center. Now go crush midlife, or at least today's to do list. Cheers.