Pelvis Party
Join us discuss women’s health and how pop culture has influenced our thinking. We’ll discuss the ins and outs of caring for your body and empower you to have conversations with your primary care provider. Brought to you by Olmsted Medical Center.
Pelvis Party
Life After Surgical Menopause | Pelvis Party
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Welcome back to the Pelvis Party! Today, we are so glad to have Heather Thompson, a patient at Olmsted Medical Center, back on the show to talk a bit about what life has been like since the surgery. The good, the bad, and the in-between. Thank you so much, Heather for being vulnerable and sharing your story with us!
Thank you also to Melissa Richards, MD, our favorite OBGYN to share your expertise and opinions. Know that if you are going through something similar, you are not alone!
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The muscles that surround your vagina want to protect you. So if something's causing pain and irritating that tissue, guess what happens? Those muscles that surround the vagina are going to try to protect your vagina. I have patients who have charlie horses in their vagina with just the thought of having sex.
SPEAKER_02Welcome back to the pelvis party for part two of Heather's journey in menopause. Heather was diagnosed with menopause at the age of 29, and she shared some intimate details of what that struggle was like at such a young age, her symptoms, infertility struggles, and much more. So take a look back at that episode to get the context on Heather's journey, and we're here to talk about what life has been like since then. Welcome back, Heather and Dr. Richards. Thank you for joining us again. So, Heather, post-menopause. What's your life like now? What symptoms do you have? What's going on?
SPEAKER_00Um, well, it's interesting, I'll tell you that. Um I've I I just turned 50 in May. Um, but I've had difference in opinions from doctors on my estrogen. I've had some try and completely take me off of it, which I absolutely have no want, need, or desire. And I very much let them know that. Going back a little bit, I've had bone density tests done, the DAXA scans done for years, and they've gradually they just keep getting worse and worse. So the last one I had done was about a month ago. And in two different areas, um, I'm like 0.2 away from um osteoporosis. I've been osteopenic for years, years and years and years.
SPEAKER_02What is that? Let's take a minute. What is osteopenic?
SPEAKER_01Yeah, tricky word, right? Yeah, it can get you into trouble sometimes. So osteopenia and osteoporosis. Osteopenia is kind of like the pre-osteoporosis. Like we have pre-diabetes, it's kind of the same idea. Um, patients who have osteopenia, we want to watch really co closely because there is a pretty good chance we're gonna move into that osteoporosis space, and we want to be able to manage that when that happens. We know that estrogen is made by our ovaries. So when we remove our ovaries, we lose that estrogen. And this is why we take removing ovaries, especially before menopause, really seriously, and because it can significantly impact your bone health, your heart health, and your brain health. We do remove ovaries though, right? When we're having significant issues, like it is something that that we do, but this can be one of the consequences of it, is it does affect bone health when we remove that estrogen before the natural age of menopause is which is between 51 and 52. And you've been experiencing that for how long would you say?
SPEAKER_00Um, I've a good probably 10 years, 10, 10, 15 years that my DEXA scans have started to go down.
SPEAKER_01And so you probably try to do things to maintain bone health as much as you can. So try to be strong and strength stuff and calcium and you know, all those things because we don't have even with estrogen supplementation, it's not the same as the estrogen that we have that our body makes. Right. Yep.
SPEAKER_02What are the what are the things that you do to maintain? Do you take supplements or what's been recommended?
SPEAKER_00Supplements have been recommended. Um and then, you know, the the estrogen does the oral estrogen that I take can help that too. That's why I get confused when they want to take it away from me.
SPEAKER_01Well, it's actually FDA approved. There aren't a lot of things that estrogen is FDA approved for, but one is hot flashes, night sweats, and the other is bone health for patients who have osteoporosis. So you're on you're on the right, you're thinking correctly. Absolutely.
SPEAKER_00Thank you very much. Absolutely. Um, another thing that is definitely been different for me. Um, you know, we uh we're girls talk, we're friends, girlfriends, and things like that. Um sex is definitely different for me as I've gotten older and gone through more of this. Um it's gotten painful. As that because the lack of estrogen?
SPEAKER_01Mm-hmm. But we I see that a lot with patients. So as as I continue to say, the vagina loves estrogen. It's what helps with the thickness of the tissue, the elasticity of the tissue, the stretchiness, as well as the lubrication. Because we don't always talk about this, especially I see it a lot with patients who go through natural menopause. They're like, I never needed to use lube before, and I'm 55 now, and I don't need to use lube, but it reflects on desire, it reflects on these things. I'm like, it reflects on your lack of estrogen. So my first step typically with a uh patient who's gone through menopause or whatever way, which way or space she's in with a lack of estrogen is oftentimes talking about um estrogen, topical estrogen, vaginal estrogen, as well as making sure to use lubrication because the the muscles that surround your vagina want to protect you. So if something's causing pain and irritating that tissue, guess what happens? Those muscles that surround the vagina are gonna try to protect your vagina. I have patients who have charlie horses in their vagina with just the thought of having sex. Those muscles are triggered. So it's really common. Um, the nice thing, the wonderful thing is we do have, you know, physical therapists who can be really helpful as well as integrating, even if you're on like an oral or systemic um estrogen or a patch, um, vaginal estrogen can be uh added to if we're still noticing issues, specifically with like vaginal dryness that is leading to all the other things. Isn't this fun?
SPEAKER_00Yeah, oh it's fun. That's so interesting.
SPEAKER_02I've never thought like protecting your muscles protecting you, but that makes a ton of sense to me. Um hardworking group. Mentally, how's that change things for you?
SPEAKER_00Mentally, mentally, it's taken a toll on me. Um I I just because it kind of snowballed this whole thing, you know, I went right from my infertility into this major surgery that did not go well into motherhood. Um and I I don't think I really unpacked, you know, the loss of my pregnancies or unpacked like losing my womanhood pretty much, you know. And and then it just was like, oh, you just this just is like moving, keep moving, keep moving. And then finally I think I got to a point where it's like maybe I need to process this because this is big time, you know. Um and so yeah, getting to a point where I I kind of thought, all right, maybe this is affecting me more than I'm waiting on. So it was it was that, and um I I notice in myself that my mental health did take a toll, a huge toll on this did. Um, and so I have to be aware of that, be mindful, and just watch because it it just has. Um and I I don't know if I just should say, well, it's because I'm 50, but also um back in my memory. Um brain fog, brain fog, brain fog, brain fog. And so I get frustrated with that, with myself, with that, and just think, you know, what are the what part of this is normal for my age, and what part of this is due to uh, you know, a cause of this. So I, you know, it's not something I lay awake at night, I you know, but it's definitely something I think about. Absolutely.
SPEAKER_02Did you seek out any resources during or even now um to help you work through any of the I have on I have on and off throughout the years. Yeah, I'm a huge advocate for therapy outside of major trauma issues on daily struggles.
SPEAKER_00So I can imagine. I'm I'm yes, I'm I'm big on that. Um but it took me a while to do to do that, but I'm very glad that I did and continue to you know stay uh on top of that.
SPEAKER_02On the pelvis party, we talk a lot about advocating for yourself, advocating for your health when you're not getting maybe the answer that you thought you should have, or it seems confusing or convoluted what you might be receiving. So, what resources are out there, Dr. Richards?
SPEAKER_01Great question. So I always like to level set. I trained at an amazing program as an OBGY, and I'm very proud of my surgical skills, my obstetric skills, my general practice. One area that has really needed some beefing up is menopause management. It just wasn't a huge focus in my residency program. Um, and that's a pretty typical story that you hear from people. And I'm trying to turn that story into a positive, meaning I it's my job now to become educated. Um so things that I like to tell patients when they're talking about menopause management is I level set that. I tell them this is my background, this is what I'm working on. Some keywords that you can ask as a patient to kind of gauge your um clinician's expertise, because that's what you're seeking, is an expert's opinion, is ask them questions about are you familiar with the North American Menopause Society? Um, and when they say yes, and did you know that was just changed to the Menopause Society? You said then you know you're working with someone really good because it has been renamed the Menopause Society. Even better that they are um have a certification through the menopause society, then you know you're working with the right people. Um I would ask, are you familiar with Dr. Jen Gunter, who is considered one of the experts in in menopause out on social media? Uh Dr. Gunter is fantastic, and you know, as recent as within the last month, they had the Menopause Society meeting, or yes, the Menopause Society meeting, and Dr. Gunter was putting out evidence-based medicine research as as the meeting was progressing. Um I think we as clinicians want to to sometimes, you know, to build trust. In order to do that, we have to be honest with our level of expertise. And and I'm very proud of where I am today as opposed to six months ago to a year ago, because I'd look at my schedule, and if I would see menopause on my schedule, I'd be like, And now like I'm jazz, like we're working through things, and it's really fun because I get to see the follow-up. Um, and and patients are so grateful to have someone who's giving resources, educating, empowering. Um, I would say for someone who's gone through uh menopause before age 45, um, whether it's surgical or um uh a natural menopause before age 45, I would really recommend working with an OBGYN or someone who is menopause society certified. Um I just think that's really important because there are so many health things that can happen if you don't have that expertise when you go through menopause before age 45 with some pretty significant health implications. Not to poo-poo hot flashes, night sweats, mood swings, um, sleep deprivation, all the things that come along with it. But as we were talking, bone health, heart health, um, the number one killer of women is cardiovascular, and estrogen plays a big role in that. So um that that would be my big plug is don't quiz them. But I would come into that meeting asking about their their, I think it's reasonable to ask about their expertise with menopause management, um, where they feel and if if they're not comfortable, that's okay that they tell you that too.
SPEAKER_02I was gonna say, or that made me think of, yeah, you don't want to quiz them, but it is okay to ask, do you have this certification? Which didn't even know that there was a menopause society certification. So that's good to know. Um, is there any tool or resource that you find particularly helpful through this journey, Heather?
SPEAKER_00Um to be honest, I'm learning all of this right now. So I'm very excited. Yeah, I definitely um I guess the couple questions that I actually would have for you is going forward now, how do you recommend someone like me to get tapped in with someone like you? So uh so that I don't have to go through some of these things in the future.
SPEAKER_01Great question. So the neat thing is at OMC, uh there was a request and I did a big menopause talk for grand rounds a couple months ago. And what has happened since then is now we're getting a bunch of referrals into our OBGYN department for menopause management. What's also really helpful is you can just literally call an OBGYN department and say, I would ask, do you have a menopause certified specialist there? If they don't, then um I would ask them who who um do you have someone who specializes in menopause management? Um, because you don't have to be certified necessarily. It's it's nice. I'm not certified and I think I do a really good job taking care of patients. Um, but once again, advocating about their expertise. That that's the big thing. And the nice thing with OBGYN is you can usually self-refer. That that would be my biggest um request. And we live in a small community, and this has been a great way to like reach out to people, but like I'm here, right? Call my office, call the OBGYN office over at OMC, and we can help direct you. I know we're doing a great job. Our partners across the street, they have a uh women's health program also. Um, but it's really important. We see people are asking for it, right? People are asking for it. And I see a lot of predatory marketing out there. Um, and other people are gonna do it if I don't do it, if I didn't do a good job of providing a relationship that's easy to get to too.
SPEAKER_02So a lot of our listeners are not local, um, but the key takeaway from that is to call your OBGYN department and ask do you have a menopause certified specialist that you can work with if you're experiencing these symptoms and you want the expertise? What's another question that you have, Heather?
SPEAKER_00So, what would you tell a 29-year-old that would come to you, you know, with okay, I just came out of of doing all these things or having all these fertility problems and I've got severe endometeurosis. Here you go, right? Walking into your office.
SPEAKER_01What I like to do is kind of level set in a way of like, we've made the right decision for today with your surgery, with the journey that we've been in. And I want us to remember this because a year from now, five years from now, ten years from now, we might be looking back at that decision and questioning our decision. And we need to respect that 29-year-old who was going through what she was going through. We really need to sit in that and remember that. So I like to do that because we're all just trying to meet people where they are at that period of time. So people can call it woo-woo, but I think it's really important. Um, and then I would tell you, we are gonna be friends for a very long time because you do require specialized treatment for all those reasons I brought up from a very like medical, physiologic standpoint. Like, I need to make sure that we're keeping your heart healthy, your brain healthy, and your bones healthy. And we need to make sure that I'm staying up to date with the most recent research because it's changing all of the time in a good way. We're getting more. So, even we've had a conversation about the management that you had at age 29. If you walked into my door with severe endometriosis, we probably maybe would be having a different conversation that didn't involve a hysterectomy and removal of your ovaries. But that's okay because that's where we were at that period of time. Um, so that would be our conversation. And I would say, yeah, once a year, you and I are gonna be hanging out at least. And really, I also tell patients to um be the crazy lady when you go out to eat and tell your friends if you feel comfortable about what's happening, because uh it's not mainstream. We don't talk about it. I don't see commercials regarding, you know, your story, and people need to understand that they're not alone, right? You talk so much about it, felt so lonely. And I see that with patients who have heavy periods, recurrent miscarriages, fertility issues, and you're not alone. You aren't. And so um I want to make sure that we feel good, that we feel like we're in a partnership, and that that would be my whole goal with that visit after um all that you've been through.
SPEAKER_02I love that. You are not alone. And while it was probably very isolating, your friends weren't going through it at the same time, all the experience that you have had so far, you are helping other women now. And that's amazing. And that's what we do at the pelvis party. We tell stories, we share experiences, and we educate women. We have Dr. Richards here. Any other questions that you have that you want to bring to light for her?
SPEAKER_00What's your opinion on an age that someone should start to wean off of estrogen? I'm sure everyone's kind of a different, you know, variation of it, but what is your recommendation? Right.
SPEAKER_01This is where you really want to make sure that you have someone you're working with that knows the most recent research that is out there and recommendations. So when I went through training, you said you start your hormone natural menopause around 51, 52, and you have hot flashes, night sweats, whatever. We'd say a year. We no longer say that. Oh, praise the Lord. We no longer say that. So we started talking about risk versus benefits, just like anything. So we know in your 50s, um, if we're getting, we want to get the benefit from the medication. So in your 50s, I feel really comfortable with someone continuing their hormone therapy, which is the estrogen component of hormone therapy. That's the good stuff. If you still have a uterus, you need to have a progestin component because as much as we love estrogen, if you have a uterus, estrogen also feeds the lining of the uterus. So you have to have progestin to keep your uterus in check. It's a whole nother pelvis party episode, guys. Um I can talk about that one too. Yeah, so exactly. Um, but it's really like what are our symptoms for you from a medical standpoint? Recommending you stay on it until age 52 from a medicine standpoint, from your bone health, once again, your heart health and your brain health, until the natural age of menopause, which is around 52. We've got some people who are well into their 50s still getting regular periods every month. Um, yay. Um, and then after at age 52, we would have a chat about like, okay, let's talk about symptoms, hot fleshes, night sweats, and some of the other symptoms that are also have been associated with menopause. And then we make a mutual decision, like what once again, risks versus benefits in your 60s. Then we start talking more about can I please have that back? Um, but once again, it still has to make sense because my 59-year-old who just went through menopause. I'm probably gonna let her continue it maybe into her 60s a bit after we talk about once again risks and benefits. Make sense.
SPEAKER_02One final question for me that I'm just kind of curious about. There's the other side of this with your partner. What's this been like for Matt, your husband, and how has he been supportive to you?
SPEAKER_00He's he's been very, very supportive along with this. Um, you know, especially like I had said too with the sexual part of it and stuff. I mean, it's it's like you know, you in the moment and it's like, oh hold on, I gotta grab a little, you know. And I there's times where I think I am more sensitive to that, where he's just like, it's fine, it's fine. But though there'll be times where I'm just like, why, why? I'm we're too young, we're too young, you know. So um no, he's been a champ, he's been great. Uh I think you know, I get moody, like probably we all do. Um, so I just tell him maybe you know, other people do that too. There's other women out there that have their days, so just relax. Um, but no, he's been he's been really, really good. I would say that's a vast majority of partners are awesome. Yeah, I'm like, hey, you're we're having sex. So what yay, hey, uh day for you.
SPEAKER_02Well, thank you for sharing. We really feel so honored that you shared your story with us and continue to help other women uh as they experience this. And Dr. Richards, your expertise, so valuable. Thank you. Absolutely. If you liked the content today, please like and follow us. And also drop us a comment in social media or on the podcast platforms that you listen to. And your question or comment might be featured in a future episode. Thank you for joining us.
