Questions We're Finally Asking—A HERology/Vitals Crossover

What if the questions women have been asking for decades are finally getting answers? 

In this special crossover episode of The Vitals and HERology, Vitals host Leslie Schlachter sits down with Drs. Joanne Stone, Anna Barbieri, and Leslee Shaw to celebrate the opening of Mount Sinai's Carolyn Rowan Center for Women's Health and Wellness—and to explore how it's reshaping women's healthcare. 

From puberty through pregnancy, perimenopause, menopause, and healthy aging, the conversation tackles the hormonal transitions that affect every stage of a woman's life. The panel separates fact from fiction on hormone therapy, GLP-1 medications, peptides, compounded drugs, and the flood of wellness advice dominating social media, while explaining why prevention, education, and personalized care matter more than ever. 

Whether you're in your 30s, 40s, 60s—or simply want to better understand women's health—this episode offers practical, evidence-based guidance from leading experts who are changing the conversation. 

Subscribe for more conversations with the physicians, researchers, and innovators advancing medicine at Mount Sinai. 

👉 To learn more about Mount Sinai’s services or to schedule an appointment with the Rowan Center, visit Mount Sinai online today: https://www.mountsinai.org/?pk_vid=174eeee090819798177342044977c34c 

Transcript

SPEAKER_01 0:00

You made a very important statement.

SPEAKER_02 0:02

Is the earlier the start, the safer it is. Like women had even no idea that they were experiencing perimenopause because again, nobody talked about it. It used to be this taboo topic. I mean, clinicians didn't know about it. So in meantime, you spent months, sometimes years, not sleeping, having a mood change, brain fog, you know, fatigue, all of those things. And you were told, well, nothing hormonal is going on because you're still getting periods. And that's not really true.

SPEAKER_03 0:38

Hello, and welcome back to the Vitals, Mount Sinai Health System's groundbreaking new podcast. I'm your host, Leslie Schlachter, a neurosurgery physician assistant here at the Mount Sinai Hospital. Today we have a special edition of the show. We're going to commemorate the opening of Mount Sinai's new Carolyn Rowan Center for Women's Health and Wellness. To discuss the opening of the center and the center's new women's health-centric podcast, Horology, we're joined by the Rowan Center's most prominent doctors. We have Dr. Joanne Stone, Dr. Anna Barbieri, and Dr. Leslie Shaw. Thank you so much for being here. Okay, so to kick us off, what is the need for a dedicated women's health center? Where did this come from?

SPEAKER_00 1:18

Well, I think that women's health has been completely under sort of resourced and has been sort of not so important. So there was a real need for having a center that really highlights women's health and how we can prevent diseases and how we can really treat people differently. You know, we're not, you know, obviously men, and you know, the biology is so different. So it was so important to have a place where we can just totally focus on women's health.

SPEAKER_03 1:46

Yeah. One of the things that we had spoken about is you said that the need is coming from a place also where you wanted to dedicate care to specific phases of women's lives. And so how do you guys do that in the center?

SPEAKER_02 1:59

For sure. You know, and that is one of the things that differentiates women's health from men's health also. There's specific transitions and phases in a woman's life like puberty, pregnancy, postpartum, perimenopause, menopause, and that these are the transitions that influence her entire health span, potentially lifespan. So we wanted to highlight that and bring it together.

SPEAKER_03 2:20

Yeah, women go through like like pre-puberty, puberty, like all the hormones that come with like getting your period, having babies. Should we so that's like a lot of hormonal changes where I guess in theory men kind of go up, stay up for a while, and then come down.

SPEAKER_02 2:35

Yeah, and uh transitions are pretty unique to women. So we just wanted to bring it all together under one roof, so to speak, and highlight that.

unknown 2:42

Okay.

SPEAKER_03 2:42

One of the things I wanted to bring up today was, you know, the whole point of this show, and I know this is a crossover show, but it's a perfect crossover for you guys, is one of the hot topics out there, especially if you're on like Instagram or TikTok or something, is we're talking about hormones, peptides, all basically anything that you can put on or in your body to improve things. So let's kind of talk. I want to start off by talking about hormones because that's what everybody wants to hear, and we need to hear it from the experts. So the hot topic out there right now is peptides. And some of the like the most popular peptide are these GLPs, which actually affect your hormones. So, like, what's the big hoopla about specifically when it I'm not talking about like just diabetes related, I'm talking about like optimization related.

SPEAKER_02 3:29

Big topic, big topic. I think maybe what I will do, let's take a step back and talk about what hormones are and what peptides are. Because I think a lot of people, and especially on Instagram, there's quite a bit of confusion over that. So peptides can be hormones, and hormones can be peptides, but they're slightly different terms. So basically, a peptide is describes the structure of something. A peptide is like a string of amino acids and amino acids for the audience's sake or building blocks of proteins. And then hormones are substances that are made by a certain organ in the body, travel through our blood, and have distinct actions on multiple or distant organs, for example. So we have peptide hormones. And you ask about GLP1's perfect example. That's just one example of a peptide hormone, but there's plenty of other ones. Um, and then we have sex hormones, which are sex steroids, and these are the hormones a lot of people talk about when it comes to the hormonal transitions in women's lives. So whether that is puberty, whether that is getting pregnant, whether that is postpartum, and certainly when it comes to perimenopause and menopause. And those transitions, for the largest part, are influenced by changes in sex hormones, so estrogen, progesterone, and testosterone. Um, and then GLP1s, you know, a subset of peptide hormones, are also influencing those transitions. Um, we understand that to a point. Um, we all have natural GLP1 hormones in our bodies, the medications that are on the market now that everybody wants to know about. So GLP1 receptor agonists, uh GIP um agonists, and there's another third one that's going to come out probably this year or next year. I'm gonna stop talking very soon, which is going to be a triple action.

SPEAKER_03 5:22

This is what people want to hear. They need to hear it from people like you, not the influencers with no medical degrees.

SPEAKER_01 5:27

So these And then I heard in Europe, though, this is just recently, just to further in, then you can answer is there's a combo now, GLP1 plus estrogen drug that is being. So just as a segue as a segue for you.

SPEAKER_02 5:41

It's a really, really exciting area that's developing, and we're just starting to understand the interplay of the of um these agents.

SPEAKER_03 5:52

So let's go in order for our our listeners. Anytime you put something on or in your body, hopefully, this is something that can be prescribed by a medical professional, not something you get off like a black market website. So there's FDA approved hormones, peptides, medications, then there's things that you can get from compounding pharmacies, and then there's things that you can get from the black market. For our listeners who can get things from doctors in all of these places, how do you know if you can get something from a website or compounding, that sounds safe to them. So how do you know the difference between what's safe and what's not and what they should be doing? Let's just focus on the hormones, I guess, and then we can get into the peptides.

SPEAKER_01 6:38

Well, I mean, uh the FDA does a rigorous process, and I think that aligning yourself with FDA-approved drugs and FBA-approved uh marketing and development of those drugs so that you understand the indications for those drugs and align yourselves. Going to a compounding pharmacy is just that. They make it there. It could be large scale, it could not be necessarily made in the United States, and there are some issues with um uh the safety of those drugs. And I I guess uh, you know, not only um would recommend staying to a pharmacy and things that are prescribed by my two folks on either side of me, um, but you know, to to stay within the FDA-approved drugs. Right. It's that's not to say there aren't websites that you can get GLP ones on that you would converse with a physician on. I would also put those in kind of a good. I mean, they're FDA approved. Right, 100%. 100%.

SPEAKER_00 7:33

But some of the I mean, there's a wide variety of compounding pharmacies, and some are really good and make really good products, and other ones are really not as reliable. Um, so I think you have to know, and and from the physician standpoint, some physicians prescribe medications from compounding form pharmacies. So you really have to know which pharmacies you can are trustworthy. Right.

SPEAKER_03 7:54

So like estrogen, progesterone, testosterone, these are all things FDA approved, you can get from any pharmacy. And then there's like Sumorlin where you have to get from like a compounding pharmacy. That's just like do you guys even use that for you?

SPEAKER_02 8:08

Do you still ask for that? So we it's not used very frequently, although there are some prescribers that are starting to use it. So the way I think about kind of the FDA approved versus compounded versus gray or black market, sort of think about those um all these compounds in three categories. First, there's FDA-approved drugs that you would get from, let's say, CVS. So we write a prescription. That um compound, that medication, that agent has gone through this rigorous FDA approval process. There is typically a randomized clinical trial that documented efficacy, safety, side effects, and so on.

SPEAKER_01 8:44

At least one, if not more.

SPEAKER_02 8:45

Correct. Then there are compounded drugs that you can get from compounding pharmacy that will have an ingredient that's FDA approved, although the creation of that particular compound is not under FDA regulation. Right. So, Sera Moralin, for example, this used to be an FDA-approved drug, I think, in the 90s. Um, and the indication was growth hormone deficiency in children. That drug is no longer produced, so it's not an FDA-approved drug, but the ingredient has gone through the FDA approval process. And that's still different from these gray market, black market.

SPEAKER_03 9:22

Where people are using it to like build muscle and cut out.

SPEAKER_02 9:24

You know, there's it's a lot of peplides in kind of the health span and longevity space that belong on that. Some of them have very, very limited to no human data and really are advertised for, you know, energy and vitality and may have just some mice studies behind them. And some will have some human data, but again, very limited. So I share this story some sometimes. I had someone email me about um a website that they were going to use to purchase these items on. And the question was, what did I think? Well, there are definitely some red flags you can look out for. If the website takes crypto, if there is no address, if it's just a random email, if it says you can contact the manufacturer and you're out on your own. Those are some really worrisome red flags. So I would definitely not recommend that. Totally in China, it could be anywhere. So when we can, you know, I think it's obviously safer, cleaner, better to use FDA-approved drugs. Um, there are compounded agents that we also use, especially in the event of cost um, shortage, supply chain issues, things like that. But again, I think it's really important to know your way around compounding pharmacies.

SPEAKER_03 10:42

So, how has your practice changed in the last year or two with like the removal of the black box warning from a hormone replacement therapy, which is, I guess, no longer the acceptable phrase. What is it supposed to be now?

SPEAKER_02 10:53

It's supposed to be hormone therapy or menopause hormone therapy, but HRT is still used all over. So it's the same thing. Aaron Powell, Jr.

SPEAKER_03 10:59

So are your patients asking you guys for replacement now and trying to optimize?

SPEAKER_01 11:04

I'll let these guys talk. I mean, I'm sharing a national guideline right now, and it's uh on primary prevention um and you know, like lipid abnormalities, et cetera. And it's caused a lot of consternation because physicians are not that well educated. You know, they've gone through 20 if it how how long was the black box? 25 years or something like that. I think more than that. 2000. Something like that. So you know, so that's just like erased it from people's minds. As clinicians, they're like, what do I do? What do you mean? People are coming in and it's like, we can hide behind it for a long time. Yeah. I don't know, you know, and and it's easier to not talk about that. Yeah, exactly. You know, just I don't want to know, right? And so I th I'll do that as a segue to you guys, but I think there is a a strong need not only for people, uh patients listening to this, but for clinicians to spend the time and figure out the key factor, and and one more thing that I'll say is whatever we use when they the black box warning uh went on to this drugs were uh higher dose oral, much different than what we use today. Right. That's a critical factor in terms of safety. The older drugs had some safety side effect profiles, which were hadn't you had to be very careful about. Today's marketplace and utilization is decided more transdermal preparations, lower dose, et cetera. And I'll I'll let the you folks uh comment on the rest of it. That is just you know where we are. People are just looking, you know, dear in the headlights, if you will. What do we do next?

SPEAKER_00 12:35

I mean, I think you you make a really good point, and I think a lot of physicians are just not educated when it comes to sort of the hormonal treatment. Um it's it's lagging in our medical students in our residency. People don't learn much about menopause or perimenopause. Um, we have internists that take care of women and don't really not sure how to prescribe medication, so we need to do a much better job of of educating the physicians, you know, whether they're internal medicine, whether you know they're OBGYNs, we need to do so much better.

SPEAKER_03 13:07

What are some of the do's and don'ts for prescribing?

SPEAKER_02 13:10

Well, I think knowing how to prescribe is is a start. And to this day, I think medical students often will look at just one hour of education on menopause in general, let alone hormone therapy. It's gonna change it's just so sad. It's just, it's just wild, you know. Um I think certainly knowing um risks and benefits. I think when the FDA warning came on um the label for hormone prescriptions many years ago, 2002, it was sort of a knee-jerk reaction to, which was supposed to be the right reaction to these older higher dose oral regimens that may not have applied to all the regimens out there. I do think the pendulum is swinging way in the opposite direction. We do see patients all the time coming in, no matter the age, no matter the medical history, no matter the need, people want hormones. So now there's this push towards hormones for everybody. And I think that redecision requires new ones. So, like somewhere in the middle. Everything, every intervention has risks, benefits, potential side effects, and needs to be a really thoughtful process.

SPEAKER_03 14:14

Right. Um, so like some of the things that you see out there, because you know, I like doom scroll a little bit on Instagram, is like I'm perimetapausal, right? So, and I started my estrogen replacement therapy probably like two years ago. I noticed a big change for me. That's for another episode. Um, but what I learned from my doctor was you don't wait until you're miserable. You started ahead of time to hopefully avoid the misery. So we did the right thing. We started the estrogen, we titrated up, I was allergic to the patches, I switched to the gel, I take my progesterone at night. So, like, what are some of those little tips and tricks? And when should women forget about like trying to do it ahead of time? When is like the right time to ask for it?

SPEAKER_00 14:52

So uh yeah, I think this is so critical. So in the uh in the Carol Rowan Center for Women's Health and Wellness, um, the pathways that have been created, and Anna and and uh her team have created different pathways, and one is a pathway specifically for four to six year olds. So you go through a guided pathway, meet with a physician first, PAs, um, and you go through a whole process so you can figure out what are the exact needs, and and it's a time to listen to somebody's symptoms.

SPEAKER_03 15:17

And it's not just like blood work, it's actually how you feel.

SPEAKER_00 15:20

It's how you feel, right? So you may need, you know, if you're having problems sleeping, you may be directed towards a sleep uh specialist. If you're having problems with, you know, half flashes, it's a no it's another form of treatment. So I think really listening to the patient and and and going through this whole guided clinical pathway is just such a differentiator in terms of what we're gonna be providing at the center.

SPEAKER_02 15:42

I think, you know, the important thing um really for any woman to know is how to recognize that her hormones are changing. And that's been a major problem in the past. Like women had even no idea that they were experiencing perimenopause because, again, nobody talked about it. It used to be this taboo topic. I mean, clinicians didn't know about it. So in the meantime, you spent months, sometimes years, not sleeping, having a mood change, brain fog, you know, fatigue, all of those things. And you were told, well, nothing hormonal is going on because you're still getting periods. And that's not really true, right? Right? You can go through this entire, you know, process and be in it for literally years without a major, major difference in your cycles. There's usually some subtle differences. And that's why, you know, we've been talking a lot about how to design better care for women in this space. And for us, it also means kind of being preemptive and proactive. So, really, by the age of 40, we believe every woman should be aware of what that change looks like. Because at least then you know what to anticipate and how to kind of figure out what's happening so you can get help.

SPEAKER_03 16:52

Would it like what's your top list of what would you say like the biggest complaints are with women that you're like, oh yeah, it's starting.

SPEAKER_01 16:59

Gaining weight. Yeah, gaining weight. Anyway, so but we need to step back as we're right. Both of you said, I think just needs to be underscored a little bit. Okay. You your estrogen levels are gonna start to decline in your late 30s. Let's just put that out there. So you are not even remotely thinking about menopause at age 35, right? Not even remotely. Right. But you're gonna start to get that decline. You need to start to have those conversations. You made a a very important statement is the earlier the start, the safer it is. If you wait until you're in your mid to late 60s and you want to have this just because you think it is, there there do become some risk and safety issues in older age women. Oh what? Well, you it can it can have some clotting uh effects. Right. So clotting to the brain, strokes, clotting in your heart, you can have a heart attack. In people who are in in the trial data, it was like 67, 70 years old and older. Okay. So there are some issues, but the big thing is to focus in on prevention early, early on within that menopausal transition, when you s and have those discussions well before you start to feel vasomotor symptoms or sleep issues or frequent UTIs or what whatever the indication is.

SPEAKER_02 18:14

And I know these are really important. Think you know, for so long we thought of menopause symptoms as hot flashes, nights with vaginal dryness. Those are symptoms that are due to low and uh and prolonged low estrogen levels. That's typically not the first symptoms of perimenopause. Usually when you look at those first initial few years, it's going to be a slight shift in periods towards shorter cycles. It's going to be worsening of PMS, it's going to be breast tenderness, it's going to be water retention, it's going to be a mood change and insomnia. That's kind of the classic set for early perimenopause.

SPEAKER_03 18:54

And what's up? I was going to say mood change is so kind. I want to like multiply that by a hundred. Impatience, you know?

SPEAKER_00 19:02

No, but it's uh such an important point. And I did have somebody that said to me that we were, I think we were giving one of our talks and whatever, and they said, you know, if I'm feeling fine, I'm 42 and I don't feel any symptoms, why would I why would I need to go go there? And because some of it is because, number one, you don't even recognize the symptoms that you are having. Number two, you want to get on that pathway of prevention and preventing all those things that you that you that Anna you just were mentioning. Yeah.

SPEAKER_02 19:30

I mean, that's not to say, you know, we d we don't need to treat every 35-year-old with hormone therapy. So I I want to be careful.

SPEAKER_03 19:36

Well, you see a pathway like at 40, they should enter your pathway at your center.

SPEAKER_02 19:40

They should people should know how to interpret the signals of their bodies by 40, if not earlier, Lizzie. I agree with you. Yeah. Earlier. Right? That doesn't mean that every 40-year-old should be on hormone therapy. We also don't want to medicalize healthy people that may not have started the process yet. Like this is super individual. We see patients who are entering that process at 35, maybe earlier, with people who really feel fine and don't notice much of anything and don't have a significant hormone.

SPEAKER_03 20:11

But why can't the process just be it's really important to get eight hours of sleep at night? It's important to eat protein and high carbs, it's important to weightlift. Maybe you should wear a weighted vest. We'll talk about that. But like sometimes the process is just like these are important things also. That lifestyle piece comes in always. Yeah.

SPEAKER_01 20:29

But they they they are more poignant, is when you start to see increases in visceral adiposity, i.e., your waist circumference gets larger. Um, and you know, you go from a population that has, you know, a 20, 30 percent obesity to 60 percent. You you have an increase in insulin resistance, your cholesterol goes up, your good cholesterol, your HDL cholesterol goes down, insulin resistant, all of these factors increase very dramatically in the prevalence of the R. And that starts in early perimenopause, too.

SPEAKER_03 21:02

So the pathway needs to start at 30, ladies.

SPEAKER_01 21:04

You need to be early. You need to be early to avert some of these because these medications, uh menopausal hormone therapy or hormone therapy, will actually ameliorate, um, actually reduce visceral adiposity. They'll improve insulin resistance, they'll maintain your cholesterol, they'll, you know, they'll they'll have very positive cardiometabolic effects, which are so important to when you're talking about lifestyle changes. Right. You know, when you talk about lifestyle changes, they're most poignant to the to the woman who's gained weight, not that I'm pointing and my looking at myself in the mirror. But you know, I think that and so if you can avert those, isn't that the best way to do it?

SPEAKER_02 21:43

It is, yeah. So sorry, I think we're we're at a point in time when there is this massive sea change in how we think about hormone therapy. Up to recently, hormone therapy used to be viewed, and this is what it's still actually FDA approved for, as A short-term intervention for specific symptoms, like a course of antibiotics. Let's say you've got a UTI use antibiotics, you've got hot flashes. Okay, use hormones for six months, no longer than two years. Now we're starting to finally look at hormones as something very different, similar to what I would say, you know, Leslie comes from the cardiology world. Blood pressure management, right? For prevention of stroke, hormone therapy really changes physiology, metabolism, long-term outcomes. So it's really, we're moving away from looking at this as this temporary fixed for symptoms towards improving your long-term physiology.

SPEAKER_03 22:41

Yeah, I think there's like that was helpful for me, even like the misinformation out there, or like just the little bit of information is ask your provider about hormones. It'll make you feel better. You won't yell at your partner so much. But like now, you're like, there's estrogen receptors everywhere. Unless the partner deserves it. I mean, it's not hormones are not always the excuse. Yeah. Hormones are not always the excuse. Um, so let's say you have, let's say there's a patient out there who has like a very strong history of like family history of breast cancer. They're not really like they know they're not an HRT candidate. Like, is this is your center still appropriate for them? Are there still things you can do for them?

SPEAKER_00 23:20

So this so one of the big things about the center is that, you know, we're um some of our leads, like Dr. Barbieri, Cal Pori, have gone through an integrative medicine fellowship. So there's other alternatives that we can use that are that we can bring to the table.

SPEAKER_03 23:33

Are they peptides?

SPEAKER_00 23:37

Not peptides. Um, so there are uh so many other options and things that that people don't even realize are available and that are are effective. So and we go that route too. We're not just straight, you know, Eastern, Western medicine. Right. We're doing both, right? So um so that's really important to bring to the table.

SPEAKER_02 23:59

And Leslie, like that example is such a perfect example, right? Somebody with a really strong family history of breast cancer. That's actually not a definite contraindication to hormone therapy. That's a, you know, that's a good reason to have a really well-informed discussion with that patient. Having had breast cancer, having had, you know, hormone-positive cancer, it's a different story. But family history like really changes that. So, you know, our goal is to really have women be informed of all the options they have and make the right decision for themselves.

SPEAKER_03 24:32

And what about, like, that's great, we're talking about all the women that like are in their, we added 30s, but like 40s. But what about like puberty, teenage, 20s? Like, how are we helping these women? Because you guys said that it has to start early, it has to be preventative. So, how how are we doing that for the younger generation?

SPEAKER_00 24:49

I think you know, providing care, we're providing care at all different ages. I mean, we have also postpartum pathways for patients who had um deliveries and uh pathway for that. Um, but I think bring them in and educating them. So that one of the things that we're doing the center, besides podcasts, to edge to help educate, but um we're gonna hold educational events and bring them in early. I mean, it's also a place that you can see your regular GYN and get sort of that care. I mean, a lot of people don't know that you know they're gonna start losing bone at age 30 and they have to start exercising, you know. Really, that's part of their lifestyle, that weight-bearing exercising. So we want to get to them early. So um educational programs, webinars, things like that that we'll be doing to provide care for those.

SPEAKER_02 25:30

That's such a good point. So the center is supposed to um be about a longitudinal care of women. So let's take bone mass. So something like 80 to 90 percent of our bone mass becomes accumulated by age 20. Okay, so if you think of osteoporosis, osteoporosis is really not a disease of older age. Osteoporosis, you're set up for that when you're a teenager. Like we should really look at sort of these long arcs of health and start introducing even lifestyle interventions.

SPEAKER_03 26:02

Should like all white girls be wearing weighted vests wherever they go?

SPEAKER_02 26:05

They should exercise, eat enough protein, move.

SPEAKER_03 26:09

For sure.

SPEAKER_01 26:10

You know, it's interesting because all of us in the room were trained under largely a model of caring for disease. And there's this massive shift going into earlier and earlier prevention. So we avert the diagnosis. A lot of this that we're talking about, whether it be diabetes, whether it be obesity, we can change that pathway that we're seeing today. There was a paper out last week that said that 60 percent of women are going to be obese by 2050. 60 percent. So that means in a healthcare setting, it'll be like eight. Like globally, or just in the United States? 25 percent will be diabetic, say over 60 percent will be hypertensive and high blood pressure. That trajectory has got to change. And the only way we do it is we take uh a five-year-old and ten-year-old. But how did that happen? Uh well, you know, we have the sorry, I just opened up Handover's bar. The COCAS, we don't have enough time. I mean, just look around you, how it's changed in your own eyes. You know, and and the sad thing is that we used to see it just in the United States. Now those of you know, we travel, you go to the UK or you go to China, you see obesity that you've never ever seen before.

SPEAKER_03 27:21

Our food is changing, we're staring at our bones.

SPEAKER_01 27:23

We don't actually eat all the wrong food all the time. Yeah. And it's just this massive cycle. The big thing about going to a center like this is that these guys, and as a researcher, we're changing the paradigm. We're putting, you know, the we're putting the strength in your hands, knowledge in your hands as a patient to become empowered to change your life, even if it's a few more steps than you took the day before, even if it's eating a banana or, you know, small changes. But really, really breaking that cycle. If we don't, I don't, we're gonna break the system in terms of caring for 80% of the population that's obese or diabetic or that. We're just not gonna have resources to care for people. And we're gonna start to see massive changes in life expectancy, which we which would be tragic.

SPEAKER_00 28:13

And I'm really uh uh listen, I'm a maternal fetal medicine specialist. So what you know, I see these patients who are obese, diabetic, hypertensive, having, you know, having babies, right? Right. So the risk to the mother is much higher. So we have, you know, and the r and also risk to the baby. There's more preterm delivery, there's more babies that are either too small or too big, and that has other health improvements.

SPEAKER_03 28:33

And those effects are lifelong. Lifelong.

SPEAKER_00 28:35

So so really, you know, it affects really so many different aspects of life.

SPEAKER_02 28:39

It's amazing. You know, we do want to empower people to live the best way that we all can to know that we have agency over our health. But it that goes to a point, and that's why we have the tools of modern medicine, whether that is hormone therapy or GLP once or whatever you have, because there are some things that it is not enough to take enough steps during the day to help with something or prevent a condition. And that's why a center like this that really combines prevention with empowerment, education, agency, and the right tools chosen in the right way for the patient in front of us. That's that's where the real power and so can change people's lives.

SPEAKER_03 29:25

So then how are people supposed to use you? So, like I have a primary care doctor, right? And if there's something not quite right, she'll say, you know, go to an endocrinologist or a cardiologist or whatever. Um, I see my gynecologist once a year. I my kids are 17 and 19, so I don't need an OB. Do you want people coming to you as an adjunct to their internal medicine doctor in primary care? Or is this like come to you guys, you'll coordinate everything that is needed for the woman?

SPEAKER_00 29:52

So I think there's a variety of things, right? So you can come in and maybe you're have uterine prolapse, you know, where the uterus is sort of too low and you need to see a um uh specialist for that, right? So you can come in and just see that person and and get that condition taken care of. Or you can have your gynecologist and say you're 42, you're starting to have symptoms. Say, you know what, this is a really great limited pathway. It's six months, go through this pathway, and then you'll come back to me at the end of it with a regime um of medications and and lifestyle changes that you've already accomplished and you're gonna continue that way. So there's different ways of doing it. I mean, in the in the postpartum pathway, that's for somebody that's 12 weeks postpartum, right? And we know that you know women who have had either vaginal delivery or even a cesarean section have certain needs. So pelvic fluorotherapy or treating the um the rectus muscles that may have separated or something like that, have these needs. So you can have your own obstetrician, come to the postpartum pathway and then go back to see a lot of people.

SPEAKER_03 30:58

So you guys are like supercharged quarterbacks for a while.

SPEAKER_02 31:00

Yeah, exactly. Okay. So the difference is, you know, let's say you're 45 and um you're not sleeping, and maybe your mood is changing, you're like, oh, I'm too stressed, I'm working too much, you know, uh, my partner is bothering me, whatever it may be, but I'll bring it up to my doctor. And most of the time, like your primary care doctor is not going to have had much menopause-related education, may not know their way around hormone therapy. Maybe you'll end up with a prescription for an antidepressant. And maybe that helps, maybe that doesn't, but that's it. And maybe you have palpitations because that is also a sign of hormonal fluctuation, and you get sent to a cardiologist. So we're trying to really change that around. So you come to the center and you go through the midlife pathway. You first start with a big, deep, personalized evaluation. What are your evaluation? What is your history? So that our clinicians do that. Biometrics, body composition, your lab values, not looking at your hormones only, because hormones also change a lot for this whole perimonopausal period, looking at your cardiometabolic risk factors, looking at your micronutrients, putting all of that together. And then we design a program for you. So our midlife pathway, it's a six-month of kind of design, curated care experience, where you go through nutritional counseling, movement counseling. Um, you may get a prescription for hormone therapy according to your need. We cover things like sexual health, metabolic health, address whether somebody needs lipid management or blood pressure management or weight management, whether that is, you know, with nutrition and movement, or whether that is medical weight loss and medical weight management. So really paying attention to all of these different tenets of health so that one can leave after six months having had a really effective, deep experience and move on with the rest of their life.

SPEAKER_01 32:52

Can I just say one more thing? It's just to ask you guys something. You know, because I know you work a lot about workflow work work efficiencies or the work up efficiencies and navigation. Maybe you should, because I think that's an important cell. You're not going to see a doctor every six months. I mean, you know, if you go to your cardiologist or this and and that evaluation becomes five years long or whatever. Right.

SPEAKER_02 33:14

No one talks to each other.

SPEAKER_01 33:15

Yes, yes. Yeah. So I I don't know if you want to talk about it.

SPEAKER_00 33:18

Because I think that's really the point. It's a really great point. So one of the great things in the center is that we have other specialties that people will talk to each other. So we have endocrinology in there, we have cardiology, we have orthopedics in there. We're hopefully we're gonna have brain health in there. Um we have um uh liver disease, GI. So these people will be nav with patient navigators, so they'll be making the appointments, they'll see the the specialists within the center, and they'll talk to each other.

SPEAKER_03 33:46

Well, you guys do telehealth also? Yeah, telehealth.

SPEAKER_00 33:49

Some of these pathways are also telehealth. So it's really you know it's so hard as a patient to navigate, you know, going to the cardiologist and then going to the endocrinologist.

SPEAKER_03 33:58

Yeah, and then so-and-so talk to so-and-so, yeah. Right.

SPEAKER_00 34:00

And then you like put it on the patient to say, well, what did they tell you? You know, like in this way. They're all talking to each other. We're in the same place. We're working together to take care of the whole person. Right. And the other thing I just wanted to mention, we've talked a lot, we've talked with young people, we've talked about perim perimenopause, menopause. We also are not forgetting about the women who are above the age of 60. You know, people are living longer now, so we want them to live longer and healthier, uh active lifestyles. So we also have a pathway that's for 60 plus that really is looking at their health, how we can optimize their health as well. So it's such an important age group, I think, that maybe is a little, is not, you know, so um in front of, you know, on Instagram and TikTok and things like that. But it's such an important age group that we're paying attention to and make their lives as, you know, wonderful and healthy as possible.

SPEAKER_03 34:50

So that's a good age group for like a lot of the educational stuff that you're doing, because that's like the lonely age group.

SPEAKER_00 34:55

Yeah.

SPEAKER_03 34:55

Like getting them out and doing maybe group things. Yeah.

SPEAKER_04 34:58

Yeah.

SPEAKER_03 34:59

Um, I know our time is coming to an end. I wanted to do rapid fire with you guys real quick. So I'm gonna say something and like pizza, and you're gonna, I'm not gonna say pizza. And you're a zero out of ten, terrible, don't like it, ten out of ten, love it, need it. You guys can all answer. All right, we're gonna start. Increase protein and diet.

SPEAKER_00 35:20

Love it and need it, you know, definitely.

SPEAKER_03 35:22

What number are we giving it?

SPEAKER_01 35:24

Nine.

SPEAKER_03 35:24

Nine.

SPEAKER_02 35:25

Because you can always overdo things. So I'll give it a nine.

SPEAKER_01 35:27

I just don't think we can meet the new dietary guidelines. I mean, it's like uh it's uh on average 60% higher than you're currently eating.

SPEAKER_03 35:36

I mean, that's the that's the thing. You have to eat cans of sardine and tuna every day and drain the oil out. Yeah. And then rotate with egg whites and rotate with chicken breast, yeah. Um increasing carbs in your diet instead of decreasing them like many women.

SPEAKER_01 35:54

If you have a very, very, very active lifestyle, you're gonna find the need for that. You know, but that is the rotation. Oh decide. I'm gonna give it a five. Because it all depends. It all depends. Yeah, I agree.

SPEAKER_03 36:05

Okay. Weighted vest.

SPEAKER_01 36:08

Hard on your joints. Hard on your joints.

SPEAKER_03 36:11

Okay, weighted vest if you're not obese.

SPEAKER_01 36:16

As long as it's not too heavy. I'll give you a big thing.

SPEAKER_03 36:18

I think they sound like you're supposed to do like 10% of your body weight.

SPEAKER_02 36:20

Yeah. Seven. Seven. I mean, I think the first thing is like, oh, you we gotta get out there and move. Yeah, okay.

SPEAKER_00 36:28

Yeah, okay. I think weight bearing is really important. So we're bones.

SPEAKER_03 36:31

And like supposedly jumping. You're supposed to like tell your joints and your bones that they're needed. Okay. Testosterone.

SPEAKER_00 36:38

Oh, that's an interesting one.

SPEAKER_02 36:41

Seven. Seven. Yeah. Uh I mean, very useful for some women. Has some side effects. Okay. Doesn't work for others. Sex.

SPEAKER_00 36:51

Do we like it? Do we want? We're talking about is it can you do it or whatever?

SPEAKER_03 36:58

Is it important for your health, happiness, and emotional well-being?

SPEAKER_00 37:02

We think so. And this is why we have somebody that's specialized in the street.

SPEAKER_02 37:05

It should be brought up. That's a 10 out of 10. Yeah. Okay. All still individual, but should be brought up. Yes.

SPEAKER_03 37:11

Getting eight hours of sleep. We're getting enough sleep, seven, eight hours.

SPEAKER_01 37:15

100. 1200. At least.

SPEAKER_03 37:17

All right. Yeah. All right. So that's a big winner so far. What about alone time or relaxation time, like de-stress time?

SPEAKER_01 37:24

15. Yeah, I agree. 100%.

SPEAKER_00 37:27

Well, it's so hard to do, but you know, it's so important. But you know, it's not yeah, it's really hard to do. I mean, try to meditate and when your mind is.

SPEAKER_02 37:37

Yeah, we're like obsessive multitaskers. Exactly. Yeah. We should do a whole podcast on that, because I think that's that's usually important. Yeah.

SPEAKER_03 37:46

I'm gonna be broad for time, but like it's the same concept of like, I want to go in hormones, I want to go in peptides, supplements. It's like, you know, taking like not talking about like the vitamin D D deficient person, just like taking extra supplements.

SPEAKER_00 37:59

Like creatine, magnesium, those are going to be pretty pretty good. So you know, it's not essential, but those have some good data behind them.

SPEAKER_02 38:08

I'm gonna go with five. Some great ones and some really stuff that really doesn't do anything. All right, last one topical retinol. Eight.

SPEAKER_01 38:17

Eight I think, yeah, we'd give it a plus plus plus. Yeah, we like it.

SPEAKER_03 38:23

Well, I want to thank you guys so much for being on the show. Is there anything that we wanted to talk about? I didn't ask you that you guys want to just throw in at the end.

SPEAKER_00 38:31

Well, just we're just so excited really about this, and thank you for you know for hosting us. And uh it's it is so important that this has become such a priority for the Monsani Health System, and we're just thrilled to be able to provide really outstanding health care to women.

SPEAKER_02 38:47

And change health care for women. Like I think it's about time.

SPEAKER_01 38:50

Yep. And get people just to check out the center. It'd be awesome.

SPEAKER_03 38:54

We need to get a line out the door because what you guys are doing, like we need to change the way that women are treated. I don't want us to be an afterthought anymore. We need to be the priority. Like, we are the priority. So let's be the priority. Exactly. Yeah, right. Be part of the revelation. Yeah.

SPEAKER_00 39:09

Thank you. Thanks.

SPEAKER_03 39:10

That's it for the show. I'm your host, Leslie Schlachter. Subscribe to the Vitals and Mount Sinai Health Systems new roundtable women's health show, Horology, on YouTube. For audio-only versions, check us out on Apple Podcasts, Spotify, or wherever you get your podcasts. For more information on the Carolyn Rowan Center for Women's Health and Wellness, or to book an appointment to see one of our specialists, scan the QR code on your screen or click the link in the description below.