OBGYN Answers YOUR Burning Questions (Pt. 1) | Pelvis Party After Clinic Hours

We are so glad OBGYN Heidi Gaston, DO, is back with us  on this week’s episode of After Clinic Hours, our mini-series where we talk about pelvic and hormonal health honestly and without shame with the clinicians who provide the care. 

Part one of Britt’s conversation with Dr. Gaston centers on YOUR social media and IRL questions. From UTIs to menstrual cycles to menopause, Dr. Gaston answers all your questions with no fluff. Just real answers and no shame! 

Make sure to check our previous After Clinic Hours episodes with Dr. Gaston and stay tuned for part 2 in a couple weeks! 

See you next week! 💞

If you have questions, please leave a comment below or submit to hello@pelvisparty.com or send us a DM! Questions will always be anonymous 💞

Follow us on social media and wherever you stream your podcasts: ➡️ 

IG: https://www.instagram.com/pelvis_party/

TikTok: https://www.tiktok.com/@pelvisparty?is_from_webapp=1&sender_device=pc 

Spotify: https://open.spotify.com/show/1XUl5XcpxktdILuiZx9kO5?si=8b4070e505dd42f5

Apple Podcasts: https://podcasts.apple.com/us/podcast/pelvis-party/id1845746327

Transcript

SPEAKER_00 0:00

How disruptive is an IUD during pre-menopause or perimenopause? What's the best birth control during this time? Welcome back to Pelvis Party Clinic After Hours, the podcast where we make health topics easier to understand and a lot less awkward to talk about. Today we're doing something a little different. We opened it up to you, our listeners, our social media community, and folks right here in Oatana to ask questions you've been curious about, maybe even a little hesitant to bring up. Joining me is Dr. Heidi Gaston. She's an OBGYN, here to give real, honest answers, no judgment, no fluff. So whether it's something you've Googled at 2 a.m. or something you've been meaning to ask your provider, this episode is for you. Dr. Gaston, welcome. Thanks. It's great to be here. Dr. Gaston actually joined us on a previous episode of After Clinic Hours. So if you haven't listened to that, go back and check it out where you can learn more about her, her personal life, her hobbies, and what she does in the clinic. What's been going on since the last time we talked, Dr. Gaston? I think you have a new driver in the house.

SPEAKER_01 1:09

Yes. So my son is now 15 years old, which means that not only are the mom in the family responsible for all of the future sex ed conversations with my son and daughters. Just ask my principal husband. I am also apparently in charge of all of the driver's education. So on the day he passed his permit test, my husband was leading a staff meeting at the school. And he said, Hey everybody, my son passed his permit test today. So my wife is going to teach him how to drive. Let's see you. Yeah, so it's going great. It's a very, very new experience for him, even with us living in the country. He has not had any experience behind the wheel prior to that permit test. But he's doing really wonderfully. And as long as we don't have too much backseat driving from the younger sisters, it goes very unremarkably. That's good. Did you uh let him drive home from the permit test? I offered. He declined. We did get a gift from a friend, a student driver magnet for the back of the vehicle, but it's a very long magnet because it says student driver in a standard one-line straight across. And, you know, Minnesota, cold. He passed in February. So the magnet cracked. So it actually is two pieces, student and driver. So when Jackson's not driving, we just pull the student sticker off, and the back of our van just says driver. And I think that there's nothing more accurate than that.

SPEAKER_00 2:45

Yeah, that makes sense, right? I also have a newly permit driver in the house. He's 15 and he declined also the same day. I think the nerves get to him. They're just nervous about passing the test, and the driving aspect is probably not on their mind.

SPEAKER_01 3:02

Yep. We ended up practicing in the parking lot that day, and it's a great thing we didn't do that on the road the first time.

SPEAKER_00 3:10

That's good.

SPEAKER_01 3:12

Other news, I am uh training for a half marathon right now. I'm going to be doing the Des Moines women's half marathon in early May. It is not a Disney run, so it will be very boring compared to the Disney runs, but no characters. Well, you might find some characters along the road. Yeah, we'll have to see if I want to spice it up with my own outfit or if I'm going to be serious about my running. There you go. And how's training going? Fine. Yeah. I I am in the minority, but I think it's very appropriate for a Minnesota weather runner. I do most of my running except the road races on a treadmill. So I watch TV while I'm running mostly. So I started watching an old show, Rosolian Isles, about a detective and the forensic pathologist. And so that's delightful. And then also dived into the handmaid's tale a little bit because the new series, The Testament, is coming and the advertisements for that were just popping up. And so I needed to see if that was a good fit for me. And I'm not sure yet.

SPEAKER_00 4:12

Yeah, we'll have to get into that offline. That's an interesting series for sure. Well, today we have pulled some questions and we're just going to go through them and put you in the hot seat and help the audience better understand what seems to be primarily around women's health topics, which is your expertise. So the first one is about menstrual cycles, when they change, how long, if they're shortening, is it a sign that it's that maybe perimenopause or menopause is starting?

SPEAKER_01 4:41

Yeah, so that's a great question. We know and expect the mencies to be somewhat irregular around the time of menarchy, which is when you first start having your period. So the age of menarchy in the United States has gone down slightly, but we expect it anywhere from nine up until 16 for most young women. And during those first couple of years that they experience their menses, it can be really irregular. And part of the reason that it's irregular is that they're typically not ovulating in a monthly fashion, like we expect most women to during the bulk of their reproductive years. As we're approaching the end of our reproductive years, that perimenopausal time frame, the same thing starts to happen in that we really don't expect or see that most of those women are ovulating regularly. So they might notice that their menses are coming more often instead of their historical every 28 to 32 days. Maybe they're experiencing mencies every 21 days, or even more frequently than that. Unfortunately, I see some women who tell me that they have a period every other week, which just sounds miserable. You might also start to see that instead of that monthly period, you're having a skipped month, two or three skipped months, six months between your last mencies. Timing of mencies can change as we approach the end of our reproductive years. And then duration of flow can change during that time as well. So most women during the bulk of their reproductive years can tell me with pretty consistent rapport that their periods last three to seven days, somewhere within that time frame. And that's consistent from month to month for them. But as they approach those perimenopausal years, the end of their reproductive timing, that can change as well. So they start to see some change in duration, either shorter or longer, more prolonged, and the amount of flow, the heaviness or lightness of the period can also adjust during that time.

SPEAKER_00 6:49

You used a term menarchy.

SPEAKER_01 6:51

Yeah.

SPEAKER_00 6:52

That is not something I'm familiar with. Can you explain that a little bit? Okay.

SPEAKER_01 6:55

So the terms of puberty, menarchy is just the initiation of menses. So just like we call menopause the cessation of menses, menarchy is the start of it. We expect in the puberty for girls, this is not men's or this is not medical terminology, but it's easy to remember. Boobs, pubes, grow, flow. So they're gonna develop their breast tissue. First, you're gonna start to see some pubic hair growth, they're gonna hit their growth spurt, and then you're gonna expect their menses. And we typically expect that girls or young women will stop with any growth about 18 months after their period has started.

SPEAKER_00 7:40

That's interesting. I didn't realize that. But it makes sense why you see like teenage girls, they have a an abundance of maybe breast tissue very quickly and then it stops at a certain point, right? Yep. Let's see. So with the cycle conversation, the question was from the time your cycle starts to change, will it eventually go away? Yeah.

SPEAKER_01 8:03

That is a great point in that it's going to change, but it is eventually going to stop. So we mark menopause as one year since your last menses occurred. So those women who are experiencing the gaps between their menses, they really need to be taking care to be cognizant of marking down when was my last period and just being aware of that so that they can know am I perimenopause? Am I still within that potential reproductive age, or am I postmenopause? And there are a couple of reasons that that's really important. One is that if they're not using any kind of contraception and they're still in perimenopause, there's still that random small percent chance of pregnancy. But also because once you're postmenopausal, any bleeding that you experience is now considered abnormal. So you really need to be able to define: am I within a time frame where this sporadic bleeding can still be considered normal? Or is this now a concern that needs to be investigated by my healthcare provider? And to be perfectly honest, this is probably worth discussing when you are in the middle of that transition, because some women are experiencing abnormal bleeding in that it's very heavy or very frequent. And it might actually be a warning sign that something has changed within their uterus and they need further investigation. So just because you're in your 40s and having changes in your menses, that doesn't mean that it's always normal. So it is worth talking to your doctor or other healthcare provider within a visit to say, is this what I should be expecting or what I'm experiencing is very normal?

SPEAKER_00 9:51

The body is so complex, and I think there is no one size fits all, especially when it comes to women's health topics and especially menstrual cycles, perimenopause, menopause. And perimenopause is something that isn't more actively talked about now, but in recent years really wasn't. How disruptive is an IUD during pre-menopause or perimenopause? What's the best birth control during this time?

SPEAKER_01 10:17

Yeah, so I think that's a great question because to be fair, the IUD, and in this regard, I'm talking about a progesterone secreting IUD. The most popular one used is called Mirena. Um, but there are many other brands available.

SPEAKER_00 10:33

And Mirena, the one with the copper.

SPEAKER_01 10:35

Nope. So Mirena is a progesterone-producing one. The most common copper one is called Perigard.

unknown 10:42

Okay.

SPEAKER_01 10:43

So if you have a progesterone-producing IUD, it is going to be, I'll say quote unquote, disruptive in that it is going to be more difficult for you to define when you are technically in menopause because you have likely not experienced a monthly menses for many years with that medication. Yay, you. That's actually a desired impact for many of the women that pursue that medication. Does it cause a health problem or a health concern that you're not having a period? And that you're not having a period around the time of perimenopause or menopause? The answer is no. So it's a benefit in that for many women, that time period can be really disruptive to their life with their heavy, unpredictable bleeding. And it's going to prevent that for many, many ladies. It is also a potential benefit for anybody that is seeking hormone replacement therapy and still has their uterus, because we typically talk about estrogen as the hormone that we're replacing with hormone replacement therapy, but you have to have estrogen coupled with estrogen to protect the uterus from endometrial hyperplasia, which is a precancer of the uterus. So if you have a morena or a different progesterone-producing IUD within the uterus, you are safe to pursue and to have those discussions about the possibility of whether estrogen is a good fit for you.

SPEAKER_00 12:19

Sticking within the IUD discussion for a minute, for women who I am one of those women who would have loved a desired outcome of no period, but that's not the case. So why would you still get your period?

SPEAKER_01 12:32

With the moraine IUD or a progesterone secreting IUD, it's a very small dose of progesterone that's being secreted by the IUD. So sometimes what we see with that is that the lining is very fragile, and you can have what we consider disrupted or disordered bleeding of the uterus. That's where part of the uterine lining sheds at this time, and then part of the uterus shed lining sheds at this time, and it's just more of an irregular, unpredictable sloughing of the endometrium. We can also see that uterine bleeding is not just due to the balance of progesterone and estrogen. So it's possible that for some women, when the morena or other progesterone secreting IUD isn't creating a menorrhea or no bleeding, their bleeding might be related to another process that's creating a problem, if you will, in that it's not enough medicine to overcome that and balance it out.

SPEAKER_00 13:36

Thank you for sharing more detail on that. We could probably do an entire episode on IUDs and heavy bleeding. You talked a little bit about hormone replacement therapy. Is that actually safe? What's going on right now in the world of hormone replacement therapy?

SPEAKER_01 13:54

Hormone replacement therapy got a bad rap a decade or two ago. There was a huge study by the women's health organization, WHO, that used hormone replacement therapy to address postmenopausal symptoms in postmenopausal women. This study was actually discontinued early because there were a number of adverse impacts noted from this hormone replacement therapy. And for several years, hormone replacement therapy was absolutely not administered for women that were already started on it. They were discontinued. Anybody that was experiencing perimenopausal or postmenopausal symptoms was not offered that type of intervention because of the results of this study. And then subsequent reevaluation of the study looked at the patient population, and a large number of the patients were actually 65 or older. That is not typically a perimenopausally aged woman. Typically, we're seeing perimenopausal in the 40s, maybe late 40s, early 50s. The average age of menopause in the United States is about 51 or 52. It kind of depends on which resource you're looking at.

SPEAKER_00 15:10

The study didn't target the ideal candidate.

SPEAKER_01 15:15

Absolutely. And when we look at that candidate, the candidate that is most harshly experiencing the symptoms of perimenopause and early menopause, they're nearly universally safe to pursue these types of medications. Notice that I don't say everybody can get this type of medication. There are definitely some contraindications. And this is why you absolutely need to have a conversation where you assess your personal risks before you dive down this path with your healthcare provider. But by and large, it has been a significant improvement in women's lives to be able to address these symptoms with hormone replacement therapy.

SPEAKER_00 16:02

Are there any downsides to hormone replacement therapy?

SPEAKER_01 16:06

There are a couple of different ways that we can get the hormone replacement therapy. And this to some extent is one of the potential downsides. So a lot of women get their estrogen replacement with a patch. Some of the patches can cause a little bit of skin irritation, especially if you're somebody who has some skin sensitivity to adhesives. So that is a potential downfall to that type of administration of medication. I've also had some patients who tell me that the patch displaying doesn't stay on very well for them. So using the patch may or may not be a good option depending on where you put it, how sweaty of a person you are naturally, how often you're showering, bathing, spending time in the pool or like. So that's one of the potential downfalls just from a route of administration perspective. Obviously, there are some potential risks associated with hormones, and that's part of the reason we talk about even in the bulk of your reproductive years, who is a good candidate for hormonally based contraception versus not. Generally speaking, the amount of hormone that we're giving a woman during their hormone replacement therapy for perimenopause or menopause is a much lower dose than what they're seeking and receiving during their reproductive years. So the risk is a slightly different balance. But it's something that needs to be evaluated on a personal level.

SPEAKER_00 17:32

A lot of my friends seem to be going through perimenopause and they're in their late 30s, early 40s, and they talk a lot about fatigue, feeling extremely exhausted all the time. And sleep is definitely probably a factor in that being disrupted often if you're sweating or if you're just waking up consistently throughout the night. Why is that such a prominent symptom?

SPEAKER_01 17:53

You know, I think sleep and fatigue have been a long-standing problem for women. And I'll say, especially moms. I can remember my mom telling me that she went to the doctor many years ago when we were kids and said, everything's fine. I'm just tired all the time. And he said, Well, that's just the way it is. You have three kids. And I think to some extent that might be true, but there may be more to it than just that. Definitely, women are crazy busy, where a lot of women are working and taking care of their family, managing all of the things that come with taking care of their family, as far as appointments and managing the household and birthday parties and bachelor parts, bachelorette parties, and bridal showers, and all of the things that women are primarily taking care of and organizing and managing. So that absolutely factors into the fatigue level. I know one of the buzzwords that we often see right now is mental load. Um, so that factors into our fatigue, and I'm saying our because I'm included, poor sleep is huge too. And some of that is related to an anxiety component for some women where they just can't turn off their brain at bedtime. Some of it is related to those night flashes, night sweats, hot flashes that they're experiencing that are disrupting their sleep. If we have any kind of overactive bladder and are getting up to pee during the night, that's a component in getting good rest as well. And then certainly if you're at any kind of risk for sleep apnea, that could be impacting your ability to get good rest, full sleep. With some of those conditions, you're going to potentially get eight hours of sleep, but still not feel rested in the morning. There are a number of things to discuss as far as this is what's happening, this is what's impacting my sleep. What can I do about it? How can I make this better? And that absolutely is a personalized conversation as well. But it's so much more than just that's the way it is, you've got to deal with it.

SPEAKER_00 20:03

I've heard you talk about routines, probably much like any other routine that one might have in having a sleep routine where you start to calm down your brain. You might put in your headphones with a podcast or a meditation, putting on an eye mask is just as important as any other routine. Absolutely.

SPEAKER_01 20:21

So sleep hygiene is typically the first thing that gets talked about when women or presumably men, but I don't take care of them, come in to talk about sleep. And sleep hygiene really starts with that routine, going to bed at the same time every day, waking up at the same time every day. That's really hard when you are tired because you finally get the sleep and then you feel like you're in that deep sleep and your alarm goes off. And maybe you have to get up now, or maybe you don't. But if you train your body with that sleep routine, same time wake up, same time go to bed, it will start to respond to you. The other thing that's going to be really important from a sleep hygiene perspective is that the bedroom is for sleep and sex only. So you're not eating in your bed, you're not reading in your bed, you don't have a TV in your room, even not just what not watching TV in your bed. You don't have a TV in your bedroom. And the phones. So phones are a problem. Uh-huh. So you're not looking at your phone in your bed, you're not actively engaging in a screen for an hour before bedtime. And that makes such a humongous difference in how your brain starts to adapt and turn down and get ready for sleep. And so if we can do all of those things, we often will have better sleep, even with those other factors at play.

SPEAKER_00 21:51

That's great advice. Something I still need to work on. We have a TV in our bedroom and my husband loves to read in bed. I've tried to put my phone down close. Closer to bedtime because of those things, because I know my brain isn't able to settle. Really good advice. And maybe just implementing one small habit at a time doesn't have to be all at once. Absolutely. We have a few more questions here that we'd like to get to. And this was from a community member. Vaginal estrogen. Do I need it? What about if I have had estrogen-positive breast cancer? I feel like that's specific, maybe.

SPEAKER_01 22:24

Yeah, that so having that conversation with somebody who's had hormonally based breast cancer, absolutely, we need to have kind of a one-on-one look at the pathology report, look at the treatment that they received, figure out when they were diagnosed. So lots of individual components to that. But just in general, vaginal estrogen, why do you use it? Who benefits from it? What's the point? So many women are aware of the initial symptoms of menopause, hot flashes, night sweats, smooth swings, insomnia. Those are the kind of the big four that typically hit us right at the beginning of that change in hormone production from the ovaries. But long-term implications are with bone health, cardiovascular health, and we notice a significant skin change. And so we can all kind of look around and see the difference in the integrity and stretch and appearance of a five-year-old's hands and an eight-year-old's hands, right? So part of it is just time-lived, but part of it is that estrogen helps to keep those fat stores under the skin and keep the skin integrity strong. So as we get further and further away from the time of menopause, the time of having appropriate or adequate estrogen production from our ovaries, the skin health changes too. And that is also true for the vaginal skin. We can find for women who are several years post-menopausal that they start to experience pain with intercourse because they have less stretching and responsiveness to the vaginal tissues. They have decreased lubrication. They can have microabrasions of the vaginal tissue from the stretch of intercourse. So all of those things kind of lead to this negative spiral of I'm not interested in intercourse because it causes pain and then it just perpetuates. Sometimes we'll even see from women who have chronic itching, recurrent urinary tract infections from vaginal atrophy. So we can see atrophic vaginitis, a thinning and aging of the vaginal tissues over time as women get further and further from menopause. So vaginal estrogen is replacing some of that estrogen that we no longer have from our ovarian production and keeping that tissue healthier and more able to do what we're hoping that it will do for us.

SPEAKER_00 25:02

I've heard a lot of women talk about dryness. You're talking somewhat about the age of an elasticity of skin and dryness. How does that impact the vaginal skin and also sex?

SPEAKER_01 25:16

Yeah. That dryness can definitely impact intercourse, make it less enjoyable for the woman, make it more painful for the woman. We, and I say we, as women specifically, but probably a fair number of men as well, use lotion on our face and our hands and our body, but almost never in the vagina. Do you know that there's a vaginal moisturizer available?

SPEAKER_00 25:41

I did not. And actually, we have a different episode where we talk about washing and hygiene. You're not supposed to put anything in there in the vagina.

SPEAKER_01 25:50

Except. So there is a vaginal moisturizer available. It's going to be in the same section of the drugstore or pharmacy as condoms and lubricant. So that's going to be something that you're going to use for maintenance, just like vaginal estrogen. If you're experiencing some dryness and vaginal estrogen is too expensive or you aren't a candidate for vaginal estrogen, then vaginal moisturizer might be a good alternative for you. It's not going to replace the estrogen that you've lost over time if you're a postmenopausal. So it's not completely reversing or changing that process, but it may still help with some of that discomfort or dryness that you're experiencing. Additionally, if you're experiencing dryness, it is probably worth discussing whether lubricant is something that you should add in when you're having intercourse.

SPEAKER_00 26:46

There are a ton of products on the market and marketing gets more savvy by the day. Are there certain things on the product label that people should be looking for or avoiding?

SPEAKER_01 26:57

Most of us don't actually need any of the bells and whistles. I would say that a couple of the brands that are really good as far as effectiveness, long-lasting, relatively non-abrasive, if you will, in that they're going to be well tolerated by both partners. I really like to recommend Uber lube, Uber like the car service, but they're not associated with each other, just spelled the same. And Astroglide. We actually use Astroglide even in labor and delivery to assist with vaginal deliveries. So both of those are relatively good, standard, not super expensive, well tolerated, available on some services that would deliver right to your home. So you wouldn't have to run into your friendly neighborhood gossip at the grocery store with that in your cart if you didn't want to. Yes.

SPEAKER_00 27:52

Well, we appreciate you joining the show today, Dr. Gaston. It's amazing to have an expert answer questions that I think everyone has. And sometimes we just don't want to ask. We're embarrassed, but we don't have to be. We've got you here. Um, so thank you to everyone that submitted a question. And if you have additional questions, please reach out to us on social media or you can email us at hello at pelvisparty.com. These conversations only happen because you're willing to ask them. And chances are, if you're wondering about it, someone else is too. Dr. Gaston, before we go, what's one thing you want listeners to take away from today's conversation?

SPEAKER_01 28:30

I absolutely want everybody to know that what they're experiencing is worth talking about. If you have something that you're experiencing that is bothering you, you need to talk to somebody about it. Whether it is expected for that timeframe of your life or quote unquote normal, that doesn't mean that a bothersome symptom has to be something that you have to deal with on your own.

SPEAKER_00 28:59

Absolutely. 100% do not settle. That's what we say all the time on the pelvis party. Also, we need to help each other normalize these conversations to have them more often and more importantly, have them with your provider. If you found today's episode helpful, make sure you hit the subscribe or follow button on your favorite podcast platform. It's a small thing, but it helps us grow this community and let others know we're creating content that is worth listening to. If you have more questions or topics that you want us to cover, again, please don't hesitate to reach out. We want to keep the conversation going. And until next time, this is Pelvis Party after clinic hours, making health topics easier to understand.