1 00:00:02,720 --> 00:00:05,880 Speaker 1: Hi. This is Laura Vandercamp. I'm a mother of five, 2 00:00:06,160 --> 00:00:10,200 Speaker 1: an author, journalist, and speaker. And this is Sarah Hart Hunger. 3 00:00:10,480 --> 00:00:13,480 Speaker 1: I'm a mother of three, a practicing physician and blogger. 4 00:00:13,480 --> 00:00:15,800 Speaker 1: On the side, we are two working parents who love 5 00:00:15,840 --> 00:00:19,320 Speaker 1: our careers and our families. Welcome to best of both worlds. 6 00:00:19,600 --> 00:00:22,400 Speaker 1: Here we talk about how real women manage work, family, 7 00:00:22,560 --> 00:00:25,800 Speaker 1: and time for fun. From figuring out childcare to mapping 8 00:00:25,800 --> 00:00:28,360 Speaker 1: out long term career goals. We want you to get 9 00:00:28,400 --> 00:00:33,920 Speaker 1: the most out of life. Welcome to best of both worlds. 10 00:00:33,960 --> 00:00:36,720 Speaker 1: This is Laura. This is episode one hundred and sixty nine. 11 00:00:37,680 --> 00:00:41,640 Speaker 1: In this episode, Sarah is going to be interviewing doctor 12 00:00:41,720 --> 00:00:44,800 Speaker 1: Laura Erdman, who is an obgyn who's going to be 13 00:00:44,840 --> 00:00:47,760 Speaker 1: talking about various issues that I'm sure many of us 14 00:00:47,840 --> 00:00:53,000 Speaker 1: are curious about, both hormonal, general, reproductive health, all that 15 00:00:53,040 --> 00:00:55,360 Speaker 1: good stuff. I can't wait to listen to it myself. 16 00:00:55,400 --> 00:00:56,959 Speaker 1: I'll be tuning in for the first time with all 17 00:00:56,960 --> 00:00:59,840 Speaker 1: of you. So, Sarah, it sounds like you are finally 18 00:00:59,840 --> 00:01:04,280 Speaker 1: made making all those annual appointments that yes, public service 19 00:01:04,319 --> 00:01:07,600 Speaker 1: announcement was skipped everything in the beginning of the year, 20 00:01:08,160 --> 00:01:11,560 Speaker 1: and you have insurance benefits that give you ex visits 21 00:01:11,560 --> 00:01:13,920 Speaker 1: in a calendar year. Now is the time to book 22 00:01:13,959 --> 00:01:16,480 Speaker 1: them because everyone else is. Because I actually literally went 23 00:01:16,520 --> 00:01:18,679 Speaker 1: to make a PCP appointment and they're like, sorry, you 24 00:01:18,680 --> 00:01:20,760 Speaker 1: can come in January. You're like, no, no, no, I 25 00:01:20,760 --> 00:01:22,920 Speaker 1: can't come in January. I want to come this year. 26 00:01:23,840 --> 00:01:27,080 Speaker 1: Yes now, or especially like eye appointments, you know that 27 00:01:27,160 --> 00:01:28,760 Speaker 1: often has to get done before the end of the 28 00:01:28,840 --> 00:01:32,840 Speaker 1: year or your contact lens benefits or glasses run out. Yeah, 29 00:01:32,920 --> 00:01:35,360 Speaker 1: luckily I did that, so I big. So that's another 30 00:01:35,400 --> 00:01:37,760 Speaker 1: PSA is like I like to do them all at 31 00:01:37,800 --> 00:01:39,280 Speaker 1: once because then I just remember to do them and 32 00:01:39,280 --> 00:01:41,119 Speaker 1: I don't have to think about it multiple times during 33 00:01:41,160 --> 00:01:42,640 Speaker 1: the year. And it does mean that that may be 34 00:01:42,720 --> 00:01:45,360 Speaker 1: like Okay, go to your OBI and your eyes and 35 00:01:45,480 --> 00:01:47,880 Speaker 1: Dunnis or whatever all at the same time, but one week. 36 00:01:50,440 --> 00:01:52,320 Speaker 1: But I find that I don't end up with you know, 37 00:01:52,400 --> 00:01:54,600 Speaker 1: some of them have different degrees of waiting, so the 38 00:01:54,600 --> 00:01:56,840 Speaker 1: appointments end up getting spread out by months. It's just 39 00:01:56,880 --> 00:01:59,360 Speaker 1: that like the act of like making them all. So 40 00:01:59,480 --> 00:02:01,080 Speaker 1: some people I know like to do that in line 41 00:02:01,080 --> 00:02:03,680 Speaker 1: with their birthday, which is sometimes what I do. But 42 00:02:03,760 --> 00:02:06,520 Speaker 1: this year didn't happen because I was like pandemic peak. 43 00:02:06,680 --> 00:02:10,680 Speaker 1: So yeah, don't forget. You still have time. You still 44 00:02:10,720 --> 00:02:13,799 Speaker 1: have time make those appointments. Maybe I should do that too. 45 00:02:14,800 --> 00:02:17,680 Speaker 1: I'm at least getting to the dentist. That's exciting. And 46 00:02:17,760 --> 00:02:20,880 Speaker 1: I specifically asked Laura if she had any intel on 47 00:02:20,919 --> 00:02:23,040 Speaker 1: a mammogram because I think you're supposed to get when 48 00:02:23,040 --> 00:02:26,679 Speaker 1: you're forty, which we both are well. So yeah, I 49 00:02:26,720 --> 00:02:29,280 Speaker 1: think the guidelines in this have been shifting that it's 50 00:02:29,320 --> 00:02:32,880 Speaker 1: not necessarily Some places do recommend at universally. Some paces say, 51 00:02:33,000 --> 00:02:35,640 Speaker 1: you know, the broader guidelines for that. If you don't 52 00:02:35,639 --> 00:02:38,200 Speaker 1: have a family history or anything that would be of concern, 53 00:02:38,520 --> 00:02:41,120 Speaker 1: then you can wait a little bit and not do 54 00:02:41,200 --> 00:02:43,799 Speaker 1: it immediately when you're forty. In any case, I talked 55 00:02:43,840 --> 00:02:46,080 Speaker 1: about it when I went in, you know, but I 56 00:02:46,160 --> 00:02:47,680 Speaker 1: was I was pregnant for much of the time when 57 00:02:47,680 --> 00:02:51,280 Speaker 1: I turned forty, and then now I'm breastfeeding, so that's 58 00:02:51,360 --> 00:02:54,240 Speaker 1: really not, you know, going to be helpful in terms 59 00:02:54,280 --> 00:02:57,280 Speaker 1: of screening either. So in my case, this has been 60 00:02:57,320 --> 00:03:00,160 Speaker 1: put off for a while. But actually that's it's a 61 00:03:00,200 --> 00:03:06,040 Speaker 1: really good excuse. Yeah, I mean, I have no familiarity 62 00:03:06,080 --> 00:03:07,840 Speaker 1: with adult, But yeah, you think I would know. I 63 00:03:07,880 --> 00:03:10,760 Speaker 1: have no idea what is recommended for any adult for anything, 64 00:03:10,840 --> 00:03:13,920 Speaker 1: so don't ask me. Yeah, well that's you know, all 65 00:03:14,000 --> 00:03:16,600 Speaker 1: the guidelines sort of change and keeping on top of 66 00:03:16,639 --> 00:03:19,520 Speaker 1: it is unclear. So but yes, if you are in 67 00:03:19,520 --> 00:03:22,360 Speaker 1: the market that you should. This is October Breast Cancer 68 00:03:22,400 --> 00:03:26,960 Speaker 1: Awareness a month, so make sure, yeah that that mammogram 69 00:03:27,600 --> 00:03:33,400 Speaker 1: thought either Sarah nor I have. I'll report back all right, 70 00:03:33,440 --> 00:03:35,000 Speaker 1: but it's not going to happen till twenty twenty one 71 00:03:35,000 --> 00:03:37,160 Speaker 1: because that's when my point, that's when your appointment is. 72 00:03:37,200 --> 00:03:39,119 Speaker 1: So there you go. All right, Well, on that note, 73 00:03:39,200 --> 00:03:42,440 Speaker 1: let's let's hear from doctor Erdman. All right, I am 74 00:03:42,480 --> 00:03:46,120 Speaker 1: so excited to introduce doctor Laura Erdman. She is an 75 00:03:46,120 --> 00:03:50,720 Speaker 1: OBGYN with expertise in well lots of things, but especially 76 00:03:50,800 --> 00:03:56,760 Speaker 1: adult hormones and treatment of periman aposal related conditions including 77 00:03:56,840 --> 00:03:59,800 Speaker 1: mood issues and everything. So would you like to introduce 78 00:03:59,840 --> 00:04:04,680 Speaker 1: your doctor Erdman. Hi, Sarah, it is my pleasure to 79 00:04:04,760 --> 00:04:07,720 Speaker 1: speak with everybody today to be on this podcast. I 80 00:04:07,760 --> 00:04:12,840 Speaker 1: am an OBGIM physician. I practice General of Centrics and 81 00:04:12,880 --> 00:04:18,160 Speaker 1: Gynecology at a community hospital in Maryland. So I see 82 00:04:18,200 --> 00:04:22,240 Speaker 1: and treat women from their late teen years all the 83 00:04:22,240 --> 00:04:26,040 Speaker 1: way through until they no longer need a gynecologist, through 84 00:04:26,200 --> 00:04:30,960 Speaker 1: their teenage years, the outset of their periods, managing their periods, 85 00:04:31,000 --> 00:04:36,320 Speaker 1: managing birth control through their child bearing years, and today, 86 00:04:36,320 --> 00:04:38,680 Speaker 1: I think specifically we're going to talk about the challenges 87 00:04:38,760 --> 00:04:41,839 Speaker 1: that arise when women hit the age of forty and 88 00:04:41,920 --> 00:04:45,640 Speaker 1: forty going into fifty, until they become postmenopausal. I've been 89 00:04:45,680 --> 00:04:50,120 Speaker 1: at my practice now for going on fifteen years, at 90 00:04:50,160 --> 00:04:52,279 Speaker 1: the same place, in the same office, so I have 91 00:04:52,360 --> 00:04:55,919 Speaker 1: patients whom I have known four fifteen years. So I 92 00:04:56,080 --> 00:04:58,760 Speaker 1: met many of these women when they were in their 93 00:04:58,839 --> 00:05:02,200 Speaker 1: early to mid twenties. I've seen them get married, help 94 00:05:02,240 --> 00:05:05,680 Speaker 1: them not get their period on their honeymoon, seeing them 95 00:05:05,760 --> 00:05:08,640 Speaker 1: have their children, and now they're coming to me when 96 00:05:08,640 --> 00:05:12,479 Speaker 1: they're forty two, forty three, forty four and life is 97 00:05:12,600 --> 00:05:15,120 Speaker 1: just changing. So hopefully we can address some of the 98 00:05:15,120 --> 00:05:17,080 Speaker 1: common things that happen at this age and how to 99 00:05:17,080 --> 00:05:20,800 Speaker 1: stay healthy. Yes, oh, I'm so excited. I think this 100 00:05:20,920 --> 00:05:22,840 Speaker 1: is great. And by the way, this was a requested 101 00:05:22,920 --> 00:05:25,640 Speaker 1: topic by some of our listeners. I think spurred on 102 00:05:25,680 --> 00:05:28,360 Speaker 1: by some of the discussion that we had about PMDD 103 00:05:28,560 --> 00:05:31,159 Speaker 1: and hormones and all that kind of stuff. So yeah, 104 00:05:31,320 --> 00:05:34,080 Speaker 1: that's exciting. And you are a mother as well. Yes, 105 00:05:34,200 --> 00:05:38,719 Speaker 1: I have four children. They are all older now. I 106 00:05:38,880 --> 00:05:41,840 Speaker 1: have a son who is a sophomore in college, although 107 00:05:41,880 --> 00:05:44,640 Speaker 1: he's home and doing virtual school right now, and I 108 00:05:44,760 --> 00:05:46,160 Speaker 1: must say I'm a little bit happy to have him 109 00:05:46,200 --> 00:05:49,600 Speaker 1: home again. My next son is a senior in high 110 00:05:49,640 --> 00:05:52,760 Speaker 1: school with his own set of challenges, trying to figure 111 00:05:52,760 --> 00:05:55,320 Speaker 1: out where to go to college side unseen. And then 112 00:05:55,360 --> 00:05:57,880 Speaker 1: I have a set of twin girls who are sophomores 113 00:05:57,920 --> 00:06:00,680 Speaker 1: in high school. Oh my god, so you are not 114 00:06:00,760 --> 00:06:02,839 Speaker 1: in the empty nest phase yet that still sounds like 115 00:06:02,880 --> 00:06:05,760 Speaker 1: a lot. Oh yes, yep, yep, yep. It's a very 116 00:06:05,760 --> 00:06:09,080 Speaker 1: full house at the moment with this. You know, big 117 00:06:09,160 --> 00:06:11,960 Speaker 1: kids have a different set of challenges. It's nice that 118 00:06:12,000 --> 00:06:13,880 Speaker 1: they can all get their own breakfast in lunch and 119 00:06:13,920 --> 00:06:15,400 Speaker 1: I don't have to worry about that, and they can 120 00:06:15,480 --> 00:06:18,200 Speaker 1: certainly do their virtual school by themselves, or should be 121 00:06:18,240 --> 00:06:21,719 Speaker 1: able to. But it's a full house and lots of 122 00:06:21,720 --> 00:06:25,400 Speaker 1: other things to consider and plan for, and not everybody's driving, 123 00:06:25,920 --> 00:06:28,159 Speaker 1: but then the ones who are driving are really worrisome too, 124 00:06:28,440 --> 00:06:32,000 Speaker 1: so it never stops, You're like, do I want you 125 00:06:32,040 --> 00:06:33,920 Speaker 1: to drive or do I want you to wait? This 126 00:06:33,960 --> 00:06:37,600 Speaker 1: is a conundrum. It is a big conundrum, but it's 127 00:06:37,600 --> 00:06:40,120 Speaker 1: overall quite liberating. I will say, it's been nice to 128 00:06:40,160 --> 00:06:44,440 Speaker 1: have an extra driver or two in the family. So cool. Well, 129 00:06:44,640 --> 00:06:47,159 Speaker 1: why don't you talk to us first about some of 130 00:06:47,200 --> 00:06:50,679 Speaker 1: the common complaints and things that you see as women 131 00:06:50,839 --> 00:06:53,960 Speaker 1: come to you either in their late thirties or early forties, 132 00:06:54,880 --> 00:06:57,440 Speaker 1: and some of the things you often suggest to help 133 00:06:57,480 --> 00:07:00,720 Speaker 1: them with it. So one of the main things, one 134 00:07:00,760 --> 00:07:04,000 Speaker 1: of the things that I tried to model my practice 135 00:07:04,040 --> 00:07:07,560 Speaker 1: around is I've been lucky to have great pediatricians for 136 00:07:07,640 --> 00:07:09,760 Speaker 1: my kids over the years, and one of the things 137 00:07:09,800 --> 00:07:13,440 Speaker 1: that I loved about them is that at their annual visit, 138 00:07:13,600 --> 00:07:17,640 Speaker 1: I sort of have gotten over the years an anticipation 139 00:07:17,720 --> 00:07:20,280 Speaker 1: of what's to come in their development. So when they 140 00:07:20,320 --> 00:07:23,840 Speaker 1: were four, I was reminded not to be surprised about nightmares. 141 00:07:23,880 --> 00:07:26,280 Speaker 1: When they were six, making sure everybody knew how to swim, 142 00:07:26,320 --> 00:07:28,720 Speaker 1: and so I've sort of modeled my practice around that. 143 00:07:29,040 --> 00:07:32,520 Speaker 1: So at different ages, I talked to women about what 144 00:07:32,680 --> 00:07:36,880 Speaker 1: to expect, what's coming, and so pretty much what I'd 145 00:07:36,960 --> 00:07:40,800 Speaker 1: like to cover when women turn forty is first of 146 00:07:40,800 --> 00:07:44,920 Speaker 1: all period of regularities. So periods go wacky at the 147 00:07:44,960 --> 00:07:48,040 Speaker 1: age of forty for many, many, many women. Sometimes they 148 00:07:48,080 --> 00:07:51,800 Speaker 1: get closer together, sometimes they get heavier, sometimes they get longer, 149 00:07:52,320 --> 00:07:56,160 Speaker 1: And it's really important to know what is normal versus 150 00:07:56,200 --> 00:07:59,240 Speaker 1: what is just what is abnormal and could be a 151 00:07:59,240 --> 00:08:02,480 Speaker 1: sign of something being wrong. So I try to explain 152 00:08:02,880 --> 00:08:04,960 Speaker 1: what's going on in the background because that helps a 153 00:08:04,960 --> 00:08:07,400 Speaker 1: lot of women understand. And a lot of women whom 154 00:08:07,400 --> 00:08:10,360 Speaker 1: I see just want to know that everything is okay. 155 00:08:10,760 --> 00:08:14,000 Speaker 1: They see some changes, they don't necessarily they're not bothered 156 00:08:14,000 --> 00:08:15,760 Speaker 1: by them, they don't necessarily want to treat them or 157 00:08:15,760 --> 00:08:17,520 Speaker 1: go on any medicine. They just want to know that 158 00:08:17,560 --> 00:08:19,760 Speaker 1: everything is okay. But when you see a change in 159 00:08:19,760 --> 00:08:22,360 Speaker 1: your period, when you've always had a perfectly regular monthly 160 00:08:22,440 --> 00:08:23,840 Speaker 1: period and now all of a sudden it is coming 161 00:08:23,880 --> 00:08:27,520 Speaker 1: every three weeks, that might seem abnormal where it actually isn't. 162 00:08:28,120 --> 00:08:30,880 Speaker 1: So it's important to remember that in the background, our 163 00:08:30,960 --> 00:08:35,160 Speaker 1: ovaries are getting older, and so they have a limited lifespan, 164 00:08:35,280 --> 00:08:38,320 Speaker 1: which is around forty five to fifty years. By about 165 00:08:38,360 --> 00:08:41,040 Speaker 1: the age of fifty or fifty one, most women start 166 00:08:41,080 --> 00:08:43,800 Speaker 1: the transition into menopause, which means their ovaries just stop 167 00:08:44,080 --> 00:08:47,000 Speaker 1: responding to the input from the brain. They stop making 168 00:08:47,000 --> 00:08:50,960 Speaker 1: their hormones and they stop ovulating. But before that they 169 00:08:51,000 --> 00:08:55,599 Speaker 1: get a little bit lazy and they don't really respond, 170 00:08:56,160 --> 00:08:58,719 Speaker 1: They don't really let the brain know too well that 171 00:08:58,800 --> 00:09:02,520 Speaker 1: they're still doing their so your brain starts driving them 172 00:09:02,559 --> 00:09:05,160 Speaker 1: a little bit harder. The brain doesn't age. The brain 173 00:09:05,200 --> 00:09:08,240 Speaker 1: would like our overs to keep working for forever, so 174 00:09:08,360 --> 00:09:11,280 Speaker 1: that signal from the brain gets really, really really strong. 175 00:09:11,720 --> 00:09:14,199 Speaker 1: But sometimes the overis say, okay, fine, I got it, 176 00:09:14,400 --> 00:09:17,600 Speaker 1: I'll do my thing, And so you get pretty much 177 00:09:17,760 --> 00:09:22,160 Speaker 1: higher highs and lower lows of your normal hormones, and 178 00:09:22,360 --> 00:09:26,480 Speaker 1: the cycle length between your periods gets a little bit 179 00:09:26,520 --> 00:09:29,040 Speaker 1: shorter because the ovaries are almost working a little bit 180 00:09:29,080 --> 00:09:31,679 Speaker 1: too well in response to that signal from the brain. 181 00:09:32,320 --> 00:09:34,560 Speaker 1: So that's why if you've had a period that has 182 00:09:34,600 --> 00:09:36,880 Speaker 1: always been every twenty eight days and now all of 183 00:09:36,920 --> 00:09:39,400 Speaker 1: a sudden, it's twenty four days, that seems to you 184 00:09:39,480 --> 00:09:41,760 Speaker 1: like it's almost a week too early, but it's not. 185 00:09:41,880 --> 00:09:44,839 Speaker 1: That's totally fine. That's just the brain responding to that 186 00:09:44,920 --> 00:09:48,040 Speaker 1: increased influence from the or the ovaries responding to the 187 00:09:48,120 --> 00:09:51,760 Speaker 1: increased signal from the brain. But also since your hormones 188 00:09:51,800 --> 00:09:54,760 Speaker 1: are hitting your ovarian hormones, your estrogen progesterone are hitting 189 00:09:54,800 --> 00:09:59,240 Speaker 1: higher highs and lower lows. Things like pms can become 190 00:09:59,280 --> 00:10:01,760 Speaker 1: a little bit more sacurbated if you have a much 191 00:10:01,880 --> 00:10:05,000 Speaker 1: higher progesterone level in that second half of your cycle. 192 00:10:05,800 --> 00:10:09,360 Speaker 1: Some people actually start to feel the beginning of hot 193 00:10:09,400 --> 00:10:12,240 Speaker 1: flashes right before their period as your estrogen is hitting 194 00:10:12,280 --> 00:10:15,240 Speaker 1: a lower low than it ever has before. The period 195 00:10:15,280 --> 00:10:17,640 Speaker 1: can get a little bit heavier because the lining grows 196 00:10:17,679 --> 00:10:20,360 Speaker 1: a little bit thicker if that estrogen is high in 197 00:10:20,400 --> 00:10:22,720 Speaker 1: the beginning of the cycle, higher than it has been. 198 00:10:23,120 --> 00:10:25,640 Speaker 1: So all these things have a reason why they're happening, 199 00:10:25,720 --> 00:10:28,600 Speaker 1: but they can be really, really, really bother some. So 200 00:10:28,679 --> 00:10:32,880 Speaker 1: these are like higher amplitude swings, which were already annoying, 201 00:10:33,200 --> 00:10:36,320 Speaker 1: but now they are actually kind of going wider in 202 00:10:36,360 --> 00:10:39,680 Speaker 1: either direction and potentially at a higher frequency, which is 203 00:10:39,679 --> 00:10:41,320 Speaker 1: what all of us want right now, I'm just kidding. 204 00:10:42,120 --> 00:10:44,960 Speaker 1: So it's really really annoying. Now again, none of this 205 00:10:45,120 --> 00:10:49,360 Speaker 1: is there's nothing wrong with any of this. There's no illness, 206 00:10:49,360 --> 00:10:53,520 Speaker 1: there's no disease, there's nothing wrong. But it's just really 207 00:10:53,559 --> 00:10:56,160 Speaker 1: really bothers. And it comes at a time in life 208 00:10:56,200 --> 00:11:00,080 Speaker 1: where for many women, their children are getting older. There 209 00:11:00,160 --> 00:11:04,080 Speaker 1: might be other life changes, just your normal body aging. 210 00:11:04,280 --> 00:11:07,079 Speaker 1: You know, it's more difficult to lose weight, that the 211 00:11:07,400 --> 00:11:10,720 Speaker 1: joints start aching a little bit more. Perhaps there's more 212 00:11:10,760 --> 00:11:14,600 Speaker 1: responsibility in a job, and so it all just hits 213 00:11:14,679 --> 00:11:17,800 Speaker 1: all together at the very wrong time. I feel like 214 00:11:18,720 --> 00:11:22,320 Speaker 1: I wonder what the evolutionary purpose of this is, although 215 00:11:22,320 --> 00:11:24,400 Speaker 1: maybe the real answer as well, women at that age 216 00:11:24,440 --> 00:11:28,040 Speaker 1: are kind of no longer part of natural selection anyway, 217 00:11:28,200 --> 00:11:32,280 Speaker 1: so it doesn't matter. I know it's interesting, but it 218 00:11:32,320 --> 00:11:35,800 Speaker 1: does seem like very very bad timing. Can you talk 219 00:11:35,880 --> 00:11:38,880 Speaker 1: more about Well, actually, I have one question and this 220 00:11:38,920 --> 00:11:41,400 Speaker 1: comes from a little bit of a professional knowledge standpoint 221 00:11:41,480 --> 00:11:43,560 Speaker 1: that I don't understand, and maybe you'll know the answer. 222 00:11:44,320 --> 00:11:49,040 Speaker 1: So I hear you on progesterone. My personal mood issues, 223 00:11:49,160 --> 00:11:51,760 Speaker 1: I know, were like my entire second half of a 224 00:11:51,760 --> 00:11:54,760 Speaker 1: cycle into my period, and it was it would correlate 225 00:11:54,800 --> 00:11:57,600 Speaker 1: with like normally like postovulation. It was like ovulation came 226 00:11:57,640 --> 00:11:59,200 Speaker 1: and then the rest of my month was ruined, like 227 00:11:59,200 --> 00:12:02,839 Speaker 1: two to three weeks of Yeah, so why is that progesterone? 228 00:12:03,080 --> 00:12:07,320 Speaker 1: So bad. But then ocps that can sorry oral contraceptive 229 00:12:07,320 --> 00:12:11,120 Speaker 1: pills that contain progesterone, why do those not make us 230 00:12:11,120 --> 00:12:13,800 Speaker 1: feel bad? That's the conundrum that I have been personally 231 00:12:13,800 --> 00:12:19,040 Speaker 1: wondering about. So I think that it's the variation the 232 00:12:19,920 --> 00:12:24,040 Speaker 1: progesterone starting to be released right when you ovulate, peaking 233 00:12:24,360 --> 00:12:28,720 Speaker 1: and then dropping, and it's not necessarily the steady state 234 00:12:28,720 --> 00:12:30,400 Speaker 1: of the progesterone like the one that it's in the 235 00:12:30,400 --> 00:12:34,560 Speaker 1: birth control pills, but rather those wild swings, just like 236 00:12:34,760 --> 00:12:39,000 Speaker 1: some people think that in early pregnancy, the nausea and 237 00:12:39,000 --> 00:12:42,200 Speaker 1: the vomiting doesn't necessarily come from the level of hCG, 238 00:12:42,280 --> 00:12:45,400 Speaker 1: which is the pregnancy hormone being high, because everybody's pregnancy 239 00:12:45,400 --> 00:12:49,320 Speaker 1: hormone sky high. It's that rapid increase, that swing that 240 00:12:49,360 --> 00:12:52,120 Speaker 1: goes up and down, and there's some evidence for this. 241 00:12:53,080 --> 00:12:56,480 Speaker 1: I'm probably going to get it wrong, but in men 242 00:12:57,320 --> 00:13:01,120 Speaker 1: whom I know nothing about medically, but some men with 243 00:13:01,400 --> 00:13:07,480 Speaker 1: certain prostate or testicular cancers also have these wild hormonal fluctuations, 244 00:13:07,600 --> 00:13:10,160 Speaker 1: and they also have a syndrome that's very similar to 245 00:13:10,200 --> 00:13:14,240 Speaker 1: nauseum vomiting of pregnancy. And it's probably the shift, not 246 00:13:14,280 --> 00:13:17,600 Speaker 1: necessarily the level So the beauty of birth control pills 247 00:13:17,760 --> 00:13:21,560 Speaker 1: is that your hormones are steady. Every single day. You 248 00:13:21,600 --> 00:13:24,520 Speaker 1: see the exact same level of hormones. There is no 249 00:13:24,920 --> 00:13:28,679 Speaker 1: up and down, no fluctuation, no adjusting to anything. But 250 00:13:29,280 --> 00:13:32,240 Speaker 1: some people do notice from the progesterone and birth control 251 00:13:32,280 --> 00:13:34,840 Speaker 1: pills that it does make them moodier and that it 252 00:13:34,880 --> 00:13:38,520 Speaker 1: does trigger acne. So those that progesterone and the pill 253 00:13:38,600 --> 00:13:41,480 Speaker 1: can still have its progesterone like effects in the body, 254 00:13:41,679 --> 00:13:44,040 Speaker 1: but it doesn't do that to everybody. Okay, we're going 255 00:13:44,120 --> 00:13:46,560 Speaker 1: to take a very quick ad break and then more 256 00:13:46,679 --> 00:13:49,120 Speaker 1: into the different treatment options, and I have lots more 257 00:13:49,200 --> 00:14:04,920 Speaker 1: questions for you. Excellent, all right, we are back, and 258 00:14:05,080 --> 00:14:07,680 Speaker 1: we were just talking about progesterones. And I know from 259 00:14:07,720 --> 00:14:10,480 Speaker 1: my own expertise that you know there are progesterones that 260 00:14:10,520 --> 00:14:12,800 Speaker 1: are more or less androgenic in their effects, So I 261 00:14:12,840 --> 00:14:15,079 Speaker 1: would think that that might make some impact on whether 262 00:14:15,120 --> 00:14:18,720 Speaker 1: you might see things like acne. Can you talk about 263 00:14:18,800 --> 00:14:21,360 Speaker 1: well two things. Number One, if a woman for some 264 00:14:21,400 --> 00:14:24,680 Speaker 1: reason doesn't want to go on hormonal treatments but is 265 00:14:24,720 --> 00:14:27,200 Speaker 1: experiencing these wild swings, are there are other things that 266 00:14:27,240 --> 00:14:29,920 Speaker 1: they can do or quote unquote natural methods is something 267 00:14:30,000 --> 00:14:33,320 Speaker 1: that people ask me about a lot, and yeah, I 268 00:14:33,320 --> 00:14:35,800 Speaker 1: guess just go through and then what are the hormonal options, 269 00:14:35,880 --> 00:14:37,800 Speaker 1: so kind of the non hormonal things and then the 270 00:14:37,800 --> 00:14:40,640 Speaker 1: hormonal things that you might do to potentially alter some 271 00:14:40,680 --> 00:14:42,960 Speaker 1: of these swings if they are bothering you in that way. 272 00:14:43,880 --> 00:14:46,960 Speaker 1: One of the most effective non hormonal options is the anticipation. 273 00:14:47,600 --> 00:14:51,520 Speaker 1: So if you have I'm a humongous proponent and almost 274 00:14:51,560 --> 00:14:54,920 Speaker 1: require my patients to track the periods. And if you 275 00:14:55,160 --> 00:14:59,000 Speaker 1: know that you every week before you're going to get 276 00:14:59,000 --> 00:15:04,120 Speaker 1: your period are going to be cranky and tired and 277 00:15:04,440 --> 00:15:07,240 Speaker 1: hungry for food that is not good for you, Well, 278 00:15:07,280 --> 00:15:09,520 Speaker 1: maybe that is the week that you don't plan to 279 00:15:09,560 --> 00:15:12,040 Speaker 1: go to the new restaurant, or you don't plan to 280 00:15:12,080 --> 00:15:14,120 Speaker 1: go to see a movie where you're gonna eat too 281 00:15:14,160 --> 00:15:18,200 Speaker 1: much popcorn. Maybe that's the week that you don't schedule 282 00:15:18,240 --> 00:15:20,680 Speaker 1: your big meeting that you could probably do the week after. 283 00:15:21,240 --> 00:15:24,640 Speaker 1: And so that anticipation can go a very, very very 284 00:15:24,680 --> 00:15:27,280 Speaker 1: long way. If there's a difficult conversation that you wanted 285 00:15:27,280 --> 00:15:28,880 Speaker 1: to have with your boss, or with your children or 286 00:15:28,880 --> 00:15:32,760 Speaker 1: with your spouse, again, push it a week later. If 287 00:15:32,760 --> 00:15:34,880 Speaker 1: you know you're coming up on your bad week, so 288 00:15:35,040 --> 00:15:40,320 Speaker 1: that is extremely helpful. There is not much in the 289 00:15:40,360 --> 00:15:43,720 Speaker 1: way of natural supplements or herbals that has been shown 290 00:15:43,840 --> 00:15:46,840 Speaker 1: to help people try all kinds of things and they 291 00:15:46,880 --> 00:15:50,000 Speaker 1: feel better, which is great if that's what helps for you. 292 00:15:50,240 --> 00:15:52,240 Speaker 1: I honestly think that it comes back to the tracking 293 00:15:52,240 --> 00:15:55,120 Speaker 1: and the knowing when it's coming, and then that's when 294 00:15:55,160 --> 00:15:56,920 Speaker 1: they take their supplements and they feel better. But I 295 00:15:56,920 --> 00:16:00,360 Speaker 1: think it's the anticipation of knowing what's coming. In terms 296 00:16:00,400 --> 00:16:04,960 Speaker 1: of non hormonal treatment, we have mostly relied on antidepressant medications, 297 00:16:05,000 --> 00:16:10,600 Speaker 1: the whole category of selective serotonin reuptic inhibitors, which are 298 00:16:10,680 --> 00:16:14,960 Speaker 1: like your fluoxetine and sertraline, which are very very common 299 00:16:14,960 --> 00:16:18,240 Speaker 1: for the treatment of depression and anxiety, and many women 300 00:16:18,280 --> 00:16:20,480 Speaker 1: are on there already, so a reminder that these are 301 00:16:20,560 --> 00:16:24,480 Speaker 1: helping with their symptoms already is really useful for women 302 00:16:24,520 --> 00:16:27,560 Speaker 1: who don't have depression or anxiety, who don't normally take 303 00:16:27,560 --> 00:16:31,240 Speaker 1: these medicines. It's really cool that these can be taken 304 00:16:31,760 --> 00:16:34,200 Speaker 1: two weeks only for the two weeks before the period, 305 00:16:34,480 --> 00:16:37,600 Speaker 1: So again here's our period trek and comes in extraordinarily 306 00:16:37,680 --> 00:16:39,680 Speaker 1: helpful because you need to know when to start it, 307 00:16:40,000 --> 00:16:42,400 Speaker 1: so you stop taking your pill when you get your period, 308 00:16:42,680 --> 00:16:44,880 Speaker 1: and then you need to start it down the road 309 00:16:45,640 --> 00:16:47,640 Speaker 1: when it's going to be two weeks before your period. 310 00:16:48,000 --> 00:16:50,760 Speaker 1: So your period, the two halves of your period. The 311 00:16:50,800 --> 00:16:52,920 Speaker 1: first half is leading up to ovulation. The second half 312 00:16:53,000 --> 00:16:55,200 Speaker 1: is after you've ovulated. The second half is much much, 313 00:16:55,240 --> 00:16:58,080 Speaker 1: much more consistent than the first half, So once you ovulate, 314 00:16:58,080 --> 00:17:01,160 Speaker 1: the second half pretty much lasts two weeks for everybody. 315 00:17:01,280 --> 00:17:04,080 Speaker 1: It's the first half that's really variable. So when you 316 00:17:04,119 --> 00:17:06,960 Speaker 1: track your period, if you have a twenty eight day cycle, 317 00:17:07,240 --> 00:17:09,920 Speaker 1: you start this medication on day fourteen, two weeks before 318 00:17:09,920 --> 00:17:11,399 Speaker 1: you're going to get your period. But if you have 319 00:17:11,440 --> 00:17:13,200 Speaker 1: a twenty four day cycle, you're going to have to 320 00:17:13,240 --> 00:17:16,280 Speaker 1: start it on day ten after you've gotten your period. 321 00:17:16,280 --> 00:17:17,840 Speaker 1: If you're going to a period every thirty five days, 322 00:17:17,840 --> 00:17:20,720 Speaker 1: you can start it a little bit later. The wonderful 323 00:17:20,720 --> 00:17:24,439 Speaker 1: thing about taking this medication this way is that it 324 00:17:24,560 --> 00:17:27,560 Speaker 1: avoids a lot of the side effects, like a decrease 325 00:17:27,560 --> 00:17:31,240 Speaker 1: in your sex drive and the weight gain that comes 326 00:17:31,280 --> 00:17:34,439 Speaker 1: with them. Why they work, nobody really knows, because you're 327 00:17:34,480 --> 00:17:36,480 Speaker 1: supposed to be on them for like six to twelve 328 00:17:36,520 --> 00:17:39,440 Speaker 1: weeks before you stay an effect, but they do work 329 00:17:39,480 --> 00:17:42,040 Speaker 1: really really really well, and also at a very low dose. 330 00:17:42,760 --> 00:17:46,680 Speaker 1: It's difficult to remember to take them, but they do help. 331 00:17:47,080 --> 00:17:50,199 Speaker 1: It's interesting that there's one that we use for postman 332 00:17:50,240 --> 00:17:52,359 Speaker 1: aposal women and a super LOADOS for the treatment of 333 00:17:52,359 --> 00:17:57,000 Speaker 1: hot flashes also, and that is peroxetine will do that, 334 00:17:57,880 --> 00:18:00,920 Speaker 1: and it comes even marketed that way. They're doing something 335 00:18:00,960 --> 00:18:03,679 Speaker 1: at the level of the brain. We just don't understand 336 00:18:03,720 --> 00:18:06,159 Speaker 1: it perfectly well, but that is a nice alternative for 337 00:18:06,200 --> 00:18:08,840 Speaker 1: a lot of women. I remember when I learned that, 338 00:18:08,880 --> 00:18:11,120 Speaker 1: I was like, well, that goes against everything I learn. 339 00:18:12,600 --> 00:18:14,800 Speaker 1: And there are studies and I think circuline is like 340 00:18:15,280 --> 00:18:17,639 Speaker 1: the first line because I get a little bit shorter acting. 341 00:18:17,640 --> 00:18:20,159 Speaker 1: But you're right, it like shouldn't work, but apparently, but 342 00:18:20,200 --> 00:18:22,679 Speaker 1: it does. But it does, and there's so much data 343 00:18:22,760 --> 00:18:25,720 Speaker 1: confirming it. Because nobody believed it, so whoever thought of it, 344 00:18:25,760 --> 00:18:29,480 Speaker 1: I don't know, but it's brilliant. And then birth control pills, 345 00:18:29,480 --> 00:18:32,199 Speaker 1: and so it's a shame that they're called birth control 346 00:18:32,240 --> 00:18:37,159 Speaker 1: pills because really they are hormonal medications that have so 347 00:18:37,440 --> 00:18:40,639 Speaker 1: many beneficial side of so many beneficial effects, they're not 348 00:18:40,640 --> 00:18:43,760 Speaker 1: even side effects. I would even consider that the contraceptionist 349 00:18:43,800 --> 00:18:46,680 Speaker 1: side effect. Of all the goodness that they do, they 350 00:18:46,680 --> 00:18:49,000 Speaker 1: do come with their risks, so they're not for everybody. 351 00:18:49,040 --> 00:18:51,600 Speaker 1: This is something to be discussed with your own doctor. 352 00:18:51,600 --> 00:18:53,520 Speaker 1: If you're at high risk of heart disease, if you 353 00:18:53,520 --> 00:18:55,479 Speaker 1: have a family history of heart disease, if you're overweight, 354 00:18:55,520 --> 00:18:57,679 Speaker 1: if you're a smoke or if you have high blood pressure, 355 00:18:57,800 --> 00:19:00,760 Speaker 1: then probably it's not the best choice for some. But 356 00:19:01,000 --> 00:19:06,040 Speaker 1: for a woman who is at a healthy weight, who exercises, 357 00:19:06,240 --> 00:19:09,680 Speaker 1: who has no other medical problems, they can just be 358 00:19:09,880 --> 00:19:13,800 Speaker 1: life changing. They shut down the ovaries completely so you 359 00:19:13,960 --> 00:19:17,600 Speaker 1: avoid these wild swings of hormones going up and down. 360 00:19:17,880 --> 00:19:20,639 Speaker 1: They give you predictability, they give you a steady state. 361 00:19:21,119 --> 00:19:24,120 Speaker 1: There are certain pills that have certain ingredients in them. 362 00:19:24,760 --> 00:19:26,439 Speaker 1: All pills are the same. They all have estrogen and 363 00:19:26,440 --> 00:19:29,600 Speaker 1: progesterone in them. They just differ by the type of progesterone. 364 00:19:29,720 --> 00:19:31,560 Speaker 1: So when you switch around from pill to pills, just 365 00:19:31,600 --> 00:19:33,920 Speaker 1: trying to find the progesterone that agrees with you the best. 366 00:19:34,359 --> 00:19:36,800 Speaker 1: And some progesterones are really really good and have been 367 00:19:36,840 --> 00:19:39,320 Speaker 1: shown to treat PMS really well, to be really good 368 00:19:39,359 --> 00:19:43,160 Speaker 1: for acne. One long term benefit of being on birth 369 00:19:43,200 --> 00:19:45,159 Speaker 1: control pill for five years or more is that your 370 00:19:45,200 --> 00:19:47,320 Speaker 1: risk of ovarian cancer in the future will go down. 371 00:19:47,800 --> 00:19:50,200 Speaker 1: They're really good for your bones. Most of us are 372 00:19:50,800 --> 00:19:52,880 Speaker 1: starting to have a little bit of decline in our 373 00:19:52,960 --> 00:19:56,879 Speaker 1: bone density after the age of twenty really, so having 374 00:19:56,920 --> 00:19:59,719 Speaker 1: adequate estrogen levels and exercising can keep our bones from 375 00:19:59,760 --> 00:20:02,680 Speaker 1: tot fiorating book too much before we get into menopause. 376 00:20:03,280 --> 00:20:06,360 Speaker 1: But it just makes life predictable. You also really don't 377 00:20:06,400 --> 00:20:08,159 Speaker 1: ever need to have a period, and so if you 378 00:20:08,200 --> 00:20:11,080 Speaker 1: wanted to skip over the sugar pills and just never 379 00:20:11,119 --> 00:20:12,879 Speaker 1: have a period, you might have some random bleeding here 380 00:20:12,960 --> 00:20:14,399 Speaker 1: or there, but it's going to be really light. But 381 00:20:14,400 --> 00:20:17,120 Speaker 1: there's absolutely no purpose in having a period when you're 382 00:20:17,119 --> 00:20:19,840 Speaker 1: on a birth control pill. That makes life really manageable. 383 00:20:20,320 --> 00:20:22,000 Speaker 1: A lot of women in their forties again have a 384 00:20:22,119 --> 00:20:25,400 Speaker 1: period heaviness and crampiness. The pill can help manage that. 385 00:20:26,240 --> 00:20:28,840 Speaker 1: And another question that I hear is women who come 386 00:20:28,880 --> 00:20:30,600 Speaker 1: to me who've had their tupside or their husband has 387 00:20:30,600 --> 00:20:32,760 Speaker 1: had a second but they don't need birth control and 388 00:20:32,800 --> 00:20:35,160 Speaker 1: they think they can't be on a birth control pill. 389 00:20:35,480 --> 00:20:37,959 Speaker 1: And again that is such a misconception. So I call 390 00:20:38,000 --> 00:20:42,040 Speaker 1: them hormone pills. I also call them well, so for me, 391 00:20:42,040 --> 00:20:44,240 Speaker 1: it's a very different angle. It's usually that I'm trying 392 00:20:44,240 --> 00:20:46,560 Speaker 1: to treat like a fourteen year old with PCOS or something, 393 00:20:46,840 --> 00:20:48,639 Speaker 1: and if I tell the parents that we're going to 394 00:20:48,680 --> 00:20:50,680 Speaker 1: go on a birth control they will flip over and die. 395 00:20:50,760 --> 00:20:53,439 Speaker 1: So I say, yes, these are marketed as birth control, 396 00:20:53,440 --> 00:20:55,920 Speaker 1: but we're just using it as a hormone replacement supplement, 397 00:20:56,200 --> 00:21:00,080 Speaker 1: hormone pill, never ever calling them birth control pills. Well, 398 00:21:00,160 --> 00:21:01,600 Speaker 1: I have to say I have I have a couple 399 00:21:01,560 --> 00:21:03,720 Speaker 1: of comments what we said, and I love everything you said. 400 00:21:03,840 --> 00:21:06,560 Speaker 1: First of all, I feel very vindicated on my choice 401 00:21:06,560 --> 00:21:09,280 Speaker 1: to take one again because I didn't realize think ovarian 402 00:21:09,320 --> 00:21:11,520 Speaker 1: benefit was so strong, and I do have ovarian cancer 403 00:21:11,760 --> 00:21:15,359 Speaker 1: as well as osteoporosis in my family, So yay times two. 404 00:21:15,800 --> 00:21:18,040 Speaker 1: And then the other thing I will say is about 405 00:21:18,040 --> 00:21:20,600 Speaker 1: the skipping I will I guess I'll just say personally, 406 00:21:20,680 --> 00:21:24,440 Speaker 1: I have tried that and I cannot make it terribly 407 00:21:24,480 --> 00:21:26,760 Speaker 1: long without having a lot of spotting. So I guess 408 00:21:26,760 --> 00:21:28,879 Speaker 1: your mileage may vary on that one. It probably just 409 00:21:28,880 --> 00:21:32,080 Speaker 1: depends on the person and they're uterus and God knows. Oh, 410 00:21:32,200 --> 00:21:35,320 Speaker 1: very much so, so there are pills birth control pills 411 00:21:35,320 --> 00:21:38,440 Speaker 1: that are marketed where you only get a period four 412 00:21:38,480 --> 00:21:42,679 Speaker 1: times a year. That's not by accident. So when we 413 00:21:42,800 --> 00:21:45,840 Speaker 1: put somebody on those birth control pills, we tell them 414 00:21:45,880 --> 00:21:47,960 Speaker 1: give it six months. So give it until the second 415 00:21:48,000 --> 00:21:51,560 Speaker 1: package to make sure that you're not spotting all the time. 416 00:21:52,280 --> 00:21:55,560 Speaker 1: The first time that you try to skip over your period, 417 00:21:56,040 --> 00:21:58,200 Speaker 1: by the time you get to about I think it's 418 00:21:58,760 --> 00:22:01,000 Speaker 1: seven weeks or so, about fifty percent of women will 419 00:22:01,040 --> 00:22:04,120 Speaker 1: start spotting. So if you just take a four day 420 00:22:04,160 --> 00:22:06,680 Speaker 1: break in seven days of sugar pills is a little 421 00:22:06,680 --> 00:22:08,960 Speaker 1: bit too long. Four days is ideal, So you just 422 00:22:09,000 --> 00:22:11,320 Speaker 1: take a four day break, let yourself have a little 423 00:22:11,320 --> 00:22:13,960 Speaker 1: period then, and then go back on it again the 424 00:22:14,040 --> 00:22:17,919 Speaker 1: next time. But it's about nine to twelve weeks that 425 00:22:18,000 --> 00:22:20,800 Speaker 1: fifty percent of women start spotting. Take a little break, 426 00:22:21,040 --> 00:22:24,320 Speaker 1: and then it's really hard to make it past sixteen weeks. 427 00:22:24,440 --> 00:22:27,480 Speaker 1: Fourteen to sixteen weeks, it's very difficult to make it 428 00:22:27,520 --> 00:22:30,440 Speaker 1: past that point without having some spotting. That's why those 429 00:22:30,480 --> 00:22:32,960 Speaker 1: pills are marketed that way. They could have picked a 430 00:22:33,040 --> 00:22:34,680 Speaker 1: period twice a year, they could have picked a period 431 00:22:34,720 --> 00:22:37,040 Speaker 1: three times a year, but people would have hated it 432 00:22:37,119 --> 00:22:39,880 Speaker 1: because at the very end of each pack almost more 433 00:22:39,920 --> 00:22:42,120 Speaker 1: than half of people would have been spotting. So that's 434 00:22:42,160 --> 00:22:45,119 Speaker 1: why they picked a twelve week break. And that is 435 00:22:45,160 --> 00:22:47,440 Speaker 1: so interesting to know that the longer you're on it, 436 00:22:47,480 --> 00:22:50,480 Speaker 1: I guess because you're lining thins, the more lucky you 437 00:22:50,520 --> 00:22:52,520 Speaker 1: may have with stretching it out. So okay, that's very 438 00:22:52,600 --> 00:22:55,520 Speaker 1: very useful information. Now, one thing I know our listeners 439 00:22:55,560 --> 00:22:58,440 Speaker 1: are going to be curious about is what's the max 440 00:22:58,600 --> 00:23:01,679 Speaker 1: age that you can you know, so take birth control pills. 441 00:23:01,840 --> 00:23:04,360 Speaker 1: Is there a expiration? Is it like your brain will 442 00:23:04,400 --> 00:23:06,320 Speaker 1: explode the second you take a pill in your forty 443 00:23:06,359 --> 00:23:09,359 Speaker 1: five or like, you know, what's when do you have 444 00:23:09,440 --> 00:23:11,840 Speaker 1: to stop? And then what could you potentially switch to? 445 00:23:12,400 --> 00:23:14,600 Speaker 1: Oh I was hoping for that question. So one of 446 00:23:14,640 --> 00:23:17,520 Speaker 1: the other goals of being on a LOTOS birth control 447 00:23:17,520 --> 00:23:22,560 Speaker 1: pill in your forties is to completely avoid the craziness 448 00:23:22,560 --> 00:23:25,639 Speaker 1: of the transition into menopause. Let that happen in the background. 449 00:23:25,960 --> 00:23:30,040 Speaker 1: So menopause is is the transition that happens when you're 450 00:23:30,080 --> 00:23:33,119 Speaker 1: over a stop working, and it is the exact same 451 00:23:33,160 --> 00:23:38,680 Speaker 1: thing as puberty, but in reverse. But culturally we have 452 00:23:38,840 --> 00:23:44,080 Speaker 1: like no patients for perimenopausal women. So I have daughters 453 00:23:44,119 --> 00:23:47,439 Speaker 1: who are fifteen years old, and so from the age 454 00:23:47,440 --> 00:23:51,200 Speaker 1: of like eleven until now, boy, are we patient with them. 455 00:23:51,440 --> 00:23:55,000 Speaker 1: And they can scream and yell, and they can bang doors, 456 00:23:55,480 --> 00:23:59,760 Speaker 1: and a week later they're perfectly normal, beautiful human beings, 457 00:24:00,359 --> 00:24:03,600 Speaker 1: and we don't think anything of it. We call them teenagers. 458 00:24:03,600 --> 00:24:07,320 Speaker 1: We call it puberty. We're kind to them, we give 459 00:24:07,359 --> 00:24:10,040 Speaker 1: them a lot of leeway. But I am about to 460 00:24:10,080 --> 00:24:13,120 Speaker 1: turn fifty years old, and if I lose my temper, 461 00:24:13,240 --> 00:24:16,320 Speaker 1: I'm a bad mother. I had a difficult day at work. 462 00:24:16,600 --> 00:24:19,199 Speaker 1: I need more sleep, and this shouldn't happen. And so 463 00:24:19,359 --> 00:24:23,080 Speaker 1: that is really something that culturally we need to get 464 00:24:23,119 --> 00:24:27,560 Speaker 1: better at. But when you are on a Lodo's birth 465 00:24:27,560 --> 00:24:31,920 Speaker 1: control pill, again, your hormones are steady state. Your ovaries 466 00:24:31,920 --> 00:24:34,600 Speaker 1: in the background are still going through their aging process 467 00:24:34,600 --> 00:24:37,280 Speaker 1: and getting ready not to work. So for somebody again 468 00:24:37,280 --> 00:24:40,240 Speaker 1: who's healthy with no risk factors for heart disease, what 469 00:24:40,400 --> 00:24:42,760 Speaker 1: I do in my practice is when the woman gots 470 00:24:42,760 --> 00:24:44,960 Speaker 1: to be fifty years old, I'll ask her to go 471 00:24:45,080 --> 00:24:47,439 Speaker 1: off of her pill and I'll send her to the 472 00:24:47,520 --> 00:24:50,560 Speaker 1: lab to check the hormone that the brain makes that 473 00:24:50,640 --> 00:24:53,160 Speaker 1: drives the ovaries. If the ovaries aren't working and sending 474 00:24:53,200 --> 00:24:55,440 Speaker 1: a signal back, that's going to be sky high. That's 475 00:24:55,480 --> 00:24:58,040 Speaker 1: called an FSH level. So you've got to be off 476 00:24:58,040 --> 00:24:59,960 Speaker 1: your pills for a little while, like three to six weeks. 477 00:25:00,280 --> 00:25:03,080 Speaker 1: Go check an FSH level. If it's sky high and 478 00:25:03,080 --> 00:25:06,160 Speaker 1: through the roof, that means you've completed the transition into menopause. 479 00:25:06,240 --> 00:25:08,439 Speaker 1: You had no clue that it happened, and you're done. 480 00:25:08,600 --> 00:25:12,159 Speaker 1: No period irregularities, You probably didn't feel any hot flashes, 481 00:25:12,400 --> 00:25:15,320 Speaker 1: you probably had no surprises with your period and these 482 00:25:15,320 --> 00:25:18,840 Speaker 1: mood variations. If your FSH level isn't in that range yet, 483 00:25:18,880 --> 00:25:20,760 Speaker 1: you can go right back on your pill and we'll 484 00:25:20,840 --> 00:25:23,080 Speaker 1: check again in a year. So I check it fifty 485 00:25:23,119 --> 00:25:26,600 Speaker 1: one fifty two, by fifty three fifty four. I get 486 00:25:26,640 --> 00:25:29,280 Speaker 1: a little bit nervous keeping people on a birth control pill, 487 00:25:29,920 --> 00:25:32,840 Speaker 1: but usually by then most people have transitioned into menopause 488 00:25:32,920 --> 00:25:34,360 Speaker 1: or they just don't want to be on it anymore. 489 00:25:35,680 --> 00:25:39,600 Speaker 1: So then you go and if you're not feeling too well, 490 00:25:39,720 --> 00:25:43,280 Speaker 1: and then all of menopause hits and you can't sleep, 491 00:25:43,400 --> 00:25:49,800 Speaker 1: and you're having hot flashes and you have joint stiffness, 492 00:25:49,840 --> 00:25:51,840 Speaker 1: and you can't get out of bed in the morning. 493 00:25:52,800 --> 00:25:55,760 Speaker 1: Then we can talk about going on hormone replacement therapy. 494 00:25:56,240 --> 00:26:00,400 Speaker 1: So that is not for everybody, but Women's Health Initiative 495 00:26:00,400 --> 00:26:02,960 Speaker 1: study from twenty years ago has really been teased out, 496 00:26:03,080 --> 00:26:06,520 Speaker 1: so people women in their fifties can go on hormone 497 00:26:06,560 --> 00:26:10,760 Speaker 1: replacement therapy very safely right at the transition into menopause 498 00:26:10,800 --> 00:26:12,719 Speaker 1: for a short course like two to five years, so 499 00:26:12,760 --> 00:26:15,680 Speaker 1: eventually you do have to come off it without increasing 500 00:26:15,720 --> 00:26:18,840 Speaker 1: their risk of breast cancer. Those heart disease risks are 501 00:26:18,840 --> 00:26:21,240 Speaker 1: always there because that's what these hormones do, but you 502 00:26:21,240 --> 00:26:23,119 Speaker 1: don't have to worry about a risk and increase in 503 00:26:23,160 --> 00:26:27,040 Speaker 1: the risk of breast cancer. And the only difference between 504 00:26:27,240 --> 00:26:30,959 Speaker 1: a birth control pill and hermon replacement therapy is the 505 00:26:31,000 --> 00:26:34,719 Speaker 1: dose level. They are the exact same medicine, but a 506 00:26:34,720 --> 00:26:37,119 Speaker 1: birth control pill is about eight to ten times higher 507 00:26:37,160 --> 00:26:39,360 Speaker 1: dose than what you need. So if you did well 508 00:26:39,400 --> 00:26:42,000 Speaker 1: on your birth control pill now you're in menopause, you 509 00:26:42,000 --> 00:26:44,480 Speaker 1: can just think of it as a dose adjustment. But 510 00:26:44,640 --> 00:26:46,159 Speaker 1: I don't want to give you ten times as much 511 00:26:46,200 --> 00:26:48,879 Speaker 1: medicine as you need. No, that totally makes sense, and 512 00:26:48,920 --> 00:26:52,040 Speaker 1: then you could maybe gradually come to a stop over 513 00:26:52,080 --> 00:26:54,800 Speaker 1: the next decade, or you know, whenever it's safe to 514 00:26:54,800 --> 00:26:57,280 Speaker 1: do so, depending on risk factors. So once you've been 515 00:26:57,320 --> 00:27:01,080 Speaker 1: on it for a few years, especially as are approaching sixty, 516 00:27:01,080 --> 00:27:02,880 Speaker 1: I'll tell them you've got to stop it. And usually 517 00:27:02,920 --> 00:27:04,800 Speaker 1: i'll wean it off over the course of six months, 518 00:27:04,960 --> 00:27:07,600 Speaker 1: because if you stop them abruptly, you'll have those hot flashes, 519 00:27:07,680 --> 00:27:10,400 Speaker 1: you won't feel too good. But there are a lot 520 00:27:10,440 --> 00:27:12,800 Speaker 1: of different ways of cutting back, little by little in 521 00:27:12,840 --> 00:27:14,959 Speaker 1: a way that takes six months. And again, if we 522 00:27:15,280 --> 00:27:17,879 Speaker 1: think about that theory of the drastic changes, if we 523 00:27:17,920 --> 00:27:19,760 Speaker 1: don't do it drastically, we do it little by little. 524 00:27:19,800 --> 00:27:22,440 Speaker 1: Your body slowly gets suggusted to a slightly little bit 525 00:27:22,480 --> 00:27:25,680 Speaker 1: lower level of estrogen as time goes on. And then 526 00:27:25,800 --> 00:27:27,640 Speaker 1: I mean eighty year old women don't have hot flashes 527 00:27:27,680 --> 00:27:31,520 Speaker 1: anymore because their bodies used to their very low estrogen level. 528 00:27:31,640 --> 00:27:33,280 Speaker 1: So you just want to do it slowly as your 529 00:27:33,320 --> 00:27:37,680 Speaker 1: body adjusts to that new you. That makes sense. Well, 530 00:27:37,720 --> 00:27:41,480 Speaker 1: that was super, super helpful. I think that people are 531 00:27:41,640 --> 00:27:45,480 Speaker 1: going to, I don't know, feel very educated after this 532 00:27:45,600 --> 00:27:49,040 Speaker 1: episode as to some of the underlying physiology of why 533 00:27:49,119 --> 00:27:51,320 Speaker 1: we feel certain ways as well. As some of the 534 00:27:51,359 --> 00:27:54,720 Speaker 1: available modalities for treatment. So I thought that was really 535 00:27:54,760 --> 00:27:58,119 Speaker 1: really helpful. What do you what do you have? I 536 00:27:58,160 --> 00:28:00,600 Speaker 1: know that one very common complaint in pair a menopause 537 00:28:00,640 --> 00:28:02,959 Speaker 1: and is something that you mentioned, which is issues with 538 00:28:03,040 --> 00:28:06,760 Speaker 1: weight and body changes. What do you tell your patients 539 00:28:06,760 --> 00:28:09,120 Speaker 1: about that or you know, what advice do you typically 540 00:28:09,200 --> 00:28:12,320 Speaker 1: give them. I think that one is the toughest one, 541 00:28:12,760 --> 00:28:16,320 Speaker 1: because all the birth control pills or homer replacement therapy 542 00:28:16,320 --> 00:28:18,480 Speaker 1: in the world is not going to help with weight, 543 00:28:18,600 --> 00:28:21,880 Speaker 1: especially with the redistribution of your weight over to across 544 00:28:21,880 --> 00:28:24,640 Speaker 1: your middle. As young women, we're used to when we're 545 00:28:24,760 --> 00:28:27,080 Speaker 1: a couple pounds over our ideal weight, it's all in 546 00:28:27,119 --> 00:28:30,080 Speaker 1: our thighs and our hips, and it's really easy to 547 00:28:30,280 --> 00:28:33,240 Speaker 1: in two weeks eat really well, exercise a little bit more, 548 00:28:33,359 --> 00:28:35,159 Speaker 1: and we get right back into our dress size. And 549 00:28:35,160 --> 00:28:37,159 Speaker 1: now all of a sudden it comes into the middle. 550 00:28:37,560 --> 00:28:39,840 Speaker 1: And I think that is a huge challenge that has 551 00:28:39,920 --> 00:28:42,800 Speaker 1: to do with the pathway that our body now uses 552 00:28:42,880 --> 00:28:46,880 Speaker 1: to metabolize our food, a really beneficial pathway is upregulated 553 00:28:46,880 --> 00:28:49,600 Speaker 1: by estrogen, and as our estrogen levels start dropping, and 554 00:28:49,600 --> 00:28:53,120 Speaker 1: all the replacement in the world isn't going to help it, 555 00:28:53,120 --> 00:28:55,120 Speaker 1: it goes down a different pathway which is more similar 556 00:28:55,160 --> 00:28:56,440 Speaker 1: to men, and so we end up with like the 557 00:28:56,480 --> 00:29:00,000 Speaker 1: analogous of a beer belly, which is really annoying. It's 558 00:29:00,200 --> 00:29:05,800 Speaker 1: time to really be conscious about what we're eating. I think, 559 00:29:06,000 --> 00:29:08,880 Speaker 1: especially for women who are lucky enough to never have 560 00:29:08,960 --> 00:29:11,560 Speaker 1: to worry about their weight, they've always been able to 561 00:29:11,560 --> 00:29:15,360 Speaker 1: eat whatever they wanted, and that's not necessarily a healthy 562 00:29:15,400 --> 00:29:20,840 Speaker 1: way of eating. So paying attention, having a majority of vegetables, 563 00:29:21,080 --> 00:29:25,000 Speaker 1: limiting your carbs to a quarter of your total meal intake, 564 00:29:25,480 --> 00:29:30,400 Speaker 1: staying well hydrated, and most importantly, staying active. And it 565 00:29:30,400 --> 00:29:33,680 Speaker 1: doesn't have to be anything fancy. Walking for thirty minutes 566 00:29:33,760 --> 00:29:38,520 Speaker 1: five times a week is going to be probably enough. 567 00:29:39,080 --> 00:29:41,000 Speaker 1: More is better. You've got to work on your strength, 568 00:29:41,000 --> 00:29:42,640 Speaker 1: you've got to work on your balance, you've got to 569 00:29:42,640 --> 00:29:44,600 Speaker 1: work on your flexibility. Those are all things to keep 570 00:29:44,640 --> 00:29:48,360 Speaker 1: you healthy as well. But it's just a matter of 571 00:29:49,440 --> 00:29:52,520 Speaker 1: watching your food intake, making really healthy choices now if 572 00:29:52,520 --> 00:29:55,080 Speaker 1: you never had to before, and then also some of 573 00:29:55,120 --> 00:29:57,640 Speaker 1: it you can't do anything about, and just accepting that 574 00:29:57,680 --> 00:29:59,840 Speaker 1: this is how it's going to be. It doesn't have 575 00:29:59,880 --> 00:30:02,000 Speaker 1: to be bad. You can manage it, but you're never 576 00:30:02,040 --> 00:30:03,280 Speaker 1: going to have the body that you did when you 577 00:30:03,320 --> 00:30:06,000 Speaker 1: were thirty. I think you know, we have to at 578 00:30:06,040 --> 00:30:07,840 Speaker 1: some point acknowledge that our bodies are only going to 579 00:30:07,880 --> 00:30:11,400 Speaker 1: age in one direction. They are. They are. No women 580 00:30:11,440 --> 00:30:13,440 Speaker 1: will ask me, well, if I take hormer replacement therapy, 581 00:30:13,480 --> 00:30:16,120 Speaker 1: will my wrinkles go away? No, that's another one that's 582 00:30:16,160 --> 00:30:21,760 Speaker 1: not going to change either. But again, sunscreen, moisturizer, getting 583 00:30:21,840 --> 00:30:24,440 Speaker 1: enough sleep, drinking enough water, you can do a lot 584 00:30:24,480 --> 00:30:28,080 Speaker 1: to make them not horrible botox. I'm sorry I didn't 585 00:30:28,080 --> 00:30:33,440 Speaker 1: say that anyway. So well, okay, this has been fantastic. 586 00:30:33,520 --> 00:30:36,320 Speaker 1: Is there anything else you would add as advice to 587 00:30:36,360 --> 00:30:38,960 Speaker 1: our listeners or anything that we didn't cover with respect 588 00:30:39,040 --> 00:30:43,400 Speaker 1: to hormones or getting older or perimenopause or anything. My 589 00:30:43,560 --> 00:30:46,760 Speaker 1: only other little plug that I love for women who 590 00:30:46,880 --> 00:30:49,160 Speaker 1: don't want to be on hormones whose main problem is 591 00:30:49,240 --> 00:30:51,720 Speaker 1: just their period and bleeding, is to remember to consider 592 00:30:51,760 --> 00:30:55,760 Speaker 1: it an IUD. They're super safe. They can last for 593 00:30:55,880 --> 00:30:58,640 Speaker 1: six years. Now. The really good ones that make your 594 00:30:58,680 --> 00:31:01,360 Speaker 1: period very light or non exist stand. And I don't 595 00:31:01,360 --> 00:31:04,560 Speaker 1: know if it's urban legend or not, but if you 596 00:31:04,640 --> 00:31:07,560 Speaker 1: go to OBGI in conferences, most of us who are 597 00:31:07,560 --> 00:31:10,800 Speaker 1: in attendance are women, and informal polls of the audience 598 00:31:10,800 --> 00:31:13,000 Speaker 1: have shown that about eighty to ninety percent of those 599 00:31:13,040 --> 00:31:16,760 Speaker 1: in attendance have one of these progesterone containing IUDs, just 600 00:31:16,840 --> 00:31:19,120 Speaker 1: because it makes your period really light or non existent, 601 00:31:19,160 --> 00:31:21,640 Speaker 1: and it makes life really easy to live with. So 602 00:31:22,000 --> 00:31:24,400 Speaker 1: I'm a big proponent of those two. And those do 603 00:31:24,480 --> 00:31:27,800 Speaker 1: suppress ovulation in some women too, so you may not psycho, right, 604 00:31:27,840 --> 00:31:30,160 Speaker 1: I think in some proportion it's not. It's all not 605 00:31:30,280 --> 00:31:32,600 Speaker 1: super predictable, But for women who are afraid, who don't 606 00:31:32,600 --> 00:31:35,160 Speaker 1: want any hormones at all, it's such a low dose 607 00:31:35,200 --> 00:31:37,400 Speaker 1: and it stays just within the uterus only. Really, the 608 00:31:37,440 --> 00:31:39,520 Speaker 1: amount of progesterone circulating and the rest of your body 609 00:31:39,560 --> 00:31:42,800 Speaker 1: is like almost none, so the systemic side effects are very, 610 00:31:42,880 --> 00:31:46,000 Speaker 1: very low. I did have a copper IUD for some years, 611 00:31:46,080 --> 00:31:47,840 Speaker 1: and let me tell you, I'm glad I don't have 612 00:31:47,880 --> 00:31:52,040 Speaker 1: it anymore. We know, yeah, yeah, yeah, those are there. 613 00:31:52,120 --> 00:31:54,640 Speaker 1: They're great at preventing a pregnancy, but they're not so 614 00:31:54,680 --> 00:31:56,920 Speaker 1: good for your period. It did do its job, It 615 00:31:56,920 --> 00:31:59,440 Speaker 1: did its job very nicely to prevent pregnancy, so I'm great. 616 00:31:59,480 --> 00:32:02,160 Speaker 1: I'm grateful for that, and let's remind our forty year 617 00:32:02,200 --> 00:32:04,760 Speaker 1: old and forty one and forty two, et cetera listeners 618 00:32:04,760 --> 00:32:07,400 Speaker 1: that you can get pregnant and you are not exempt 619 00:32:07,480 --> 00:32:09,240 Speaker 1: from needing birth control if you do not want to 620 00:32:09,240 --> 00:32:12,400 Speaker 1: continue to expand your family. So to remember to talk 621 00:32:12,400 --> 00:32:15,200 Speaker 1: to your objin and not just assume that once you 622 00:32:15,200 --> 00:32:18,800 Speaker 1: are at a certain point that it's not going to Yeah, yep, 623 00:32:18,880 --> 00:32:22,000 Speaker 1: the surprise babies happen all the time. Yes, and sometimes 624 00:32:22,000 --> 00:32:24,440 Speaker 1: that's welcome and wonderful. But just make sure that you've 625 00:32:24,480 --> 00:32:27,880 Speaker 1: thought about that. Okay. So one thing we do before 626 00:32:27,920 --> 00:32:30,120 Speaker 1: we sign off is we always share our love of 627 00:32:30,160 --> 00:32:32,000 Speaker 1: the week. I will go first to give you a 628 00:32:32,080 --> 00:32:34,520 Speaker 1: chance to make sure you have yours in mind. Maybe 629 00:32:34,520 --> 00:32:38,200 Speaker 1: you already do, but anyway mine is. So you guys know. 630 00:32:38,280 --> 00:32:40,880 Speaker 1: I talked about The Babysitters Club and my love for 631 00:32:40,880 --> 00:32:42,760 Speaker 1: the Netflix series as well as the book series when 632 00:32:42,800 --> 00:32:44,360 Speaker 1: I was a kid and the comic book series it 633 00:32:44,360 --> 00:32:47,600 Speaker 1: still exists now, and my daughter likes those two. The 634 00:32:47,760 --> 00:32:50,440 Speaker 1: author of a new series called The Startup Squad reached 635 00:32:50,440 --> 00:32:53,000 Speaker 1: out to me. The Startup Squad, he called, is like 636 00:32:53,040 --> 00:32:56,440 Speaker 1: the Babysitters Club of the modern age, and it's a 637 00:32:56,480 --> 00:32:58,680 Speaker 1: series book with a group of four girls that are 638 00:32:59,000 --> 00:33:02,000 Speaker 1: starting startups. And he was right. My daughter was super 639 00:33:02,160 --> 00:33:05,160 Speaker 1: super into them. They she said she loved how the 640 00:33:05,200 --> 00:33:07,880 Speaker 1: girls had all different backgrounds and all different kinds of ideas. 641 00:33:08,280 --> 00:33:10,360 Speaker 1: And so if you have kind of like an eight 642 00:33:10,440 --> 00:33:12,440 Speaker 1: year old to ten year old, maybe even like eleven, 643 00:33:12,560 --> 00:33:15,760 Speaker 1: who is into series books and want some inspirational reading 644 00:33:15,880 --> 00:33:18,280 Speaker 1: that's still really fun, you should check out Startup Squad. 645 00:33:18,320 --> 00:33:21,680 Speaker 1: And the author's names are Brian Weissfeld and Nicole Keer. 646 00:33:21,920 --> 00:33:23,920 Speaker 1: So that's my love of the week this week. Oh 647 00:33:23,960 --> 00:33:30,720 Speaker 1: that sounds awesome, very very cool and so modern too. Yes, well, 648 00:33:30,800 --> 00:33:33,720 Speaker 1: I thought long and hard about this, and my love 649 00:33:33,760 --> 00:33:36,640 Speaker 1: of the week is kind of my love of my career. 650 00:33:37,400 --> 00:33:40,080 Speaker 1: And it's an app for your phone that's a period 651 00:33:40,080 --> 00:33:44,640 Speaker 1: tracker that's called Clue. There are a bazillion different apps 652 00:33:44,720 --> 00:33:46,880 Speaker 1: out there, but I will give a shout out to 653 00:33:46,920 --> 00:33:50,080 Speaker 1: this one. It was developed by a bunch of physicians 654 00:33:50,120 --> 00:33:53,320 Speaker 1: over in Europe. There's some big health award that's given 655 00:33:53,320 --> 00:33:56,760 Speaker 1: in Europe to like the most innovative physician or development, 656 00:33:56,800 --> 00:33:59,920 Speaker 1: and several years ago this app won that award. So 657 00:34:00,320 --> 00:34:03,440 Speaker 1: it's very well maintained. The information that you can get 658 00:34:03,440 --> 00:34:06,600 Speaker 1: from it is super reliable, it's free, and you can 659 00:34:06,720 --> 00:34:11,120 Speaker 1: track absolutely everything. Often people think of using a period 660 00:34:11,200 --> 00:34:13,440 Speaker 1: tracker to see when they're going to ovulate, when they 661 00:34:13,480 --> 00:34:16,319 Speaker 1: want to get pregnant, but you can use it as 662 00:34:16,360 --> 00:34:19,520 Speaker 1: the opposite, so as a natural family planning if you 663 00:34:19,560 --> 00:34:22,240 Speaker 1: want to. But it has almost every single PMO symptom 664 00:34:22,280 --> 00:34:24,839 Speaker 1: listed and you can list your own, and so it's 665 00:34:24,960 --> 00:34:28,160 Speaker 1: really helpful. I think it's really helpful to women in general, 666 00:34:28,480 --> 00:34:30,920 Speaker 1: for me, for their physician, it's extremely helpful. So when 667 00:34:30,920 --> 00:34:32,960 Speaker 1: somebody cause and says my period is a regular, I 668 00:34:33,000 --> 00:34:34,799 Speaker 1: ask them to pull out their app and read it 669 00:34:34,840 --> 00:34:35,920 Speaker 1: off to me, and then I can tell them it 670 00:34:35,960 --> 00:34:39,239 Speaker 1: is or it isn't. So it's a good habit to 671 00:34:39,280 --> 00:34:41,359 Speaker 1: get into, and it can help avoid a lot of 672 00:34:41,440 --> 00:34:44,840 Speaker 1: worry and a lot of drama as time goes on. 673 00:34:45,160 --> 00:34:48,800 Speaker 1: And it's free, so it's nice to have. That is awesome. 674 00:34:48,880 --> 00:34:50,920 Speaker 1: I will admit I tell my patients to track, but 675 00:34:50,960 --> 00:34:52,799 Speaker 1: I don't give them a specific wreck, but now I will, 676 00:34:52,800 --> 00:34:54,600 Speaker 1: and I'm going to check it out myself. So awesome. 677 00:34:54,719 --> 00:34:57,680 Speaker 1: Good to know about CLUE. Well, thank you so much 678 00:34:57,719 --> 00:35:01,239 Speaker 1: for being on the show. This was fantastic, so informative. 679 00:35:01,360 --> 00:35:02,640 Speaker 1: I think that a lot of people are going to 680 00:35:02,680 --> 00:35:05,080 Speaker 1: get a lot out of it. Where can they find you, 681 00:35:05,280 --> 00:35:07,000 Speaker 1: if do you have social media? If they have any 682 00:35:07,000 --> 00:35:10,280 Speaker 1: other things to ask your accolades to give I do. 683 00:35:10,560 --> 00:35:14,560 Speaker 1: My practice is a small practice in suburban Maryland. It's 684 00:35:14,600 --> 00:35:18,279 Speaker 1: called it used to be called Charles Street obg I 685 00:35:18,400 --> 00:35:24,000 Speaker 1: N and so our website is www dot csobgi N 686 00:35:24,080 --> 00:35:28,280 Speaker 1: dot com. I will admit that it's my younger partner 687 00:35:28,320 --> 00:35:31,960 Speaker 1: who maintains our Facebook page, and I believe that we 688 00:35:32,120 --> 00:35:37,719 Speaker 1: do have link to it from our website, so also 689 00:35:37,760 --> 00:35:40,960 Speaker 1: on Facebook at csobg I on Charles Street obg I N. 690 00:35:41,719 --> 00:35:45,799 Speaker 1: And so, yeah, we're in suburban Baltimore, So if you're 691 00:35:45,840 --> 00:35:50,239 Speaker 1: in the area, it would be lovely. Yes, you're going 692 00:35:50,320 --> 00:35:55,520 Speaker 1: to get to both world pass very very cool. Oh 693 00:35:55,520 --> 00:35:57,840 Speaker 1: that's wonderful. All right, Well we'll have to look for 694 00:35:57,880 --> 00:36:00,480 Speaker 1: you there. Maybe I'll convince you to start an Instagram 695 00:36:00,480 --> 00:36:02,160 Speaker 1: handle by the time this airs and we can link 696 00:36:02,200 --> 00:36:05,239 Speaker 1: to you there as well. Oh yeah, but thank you, 697 00:36:05,480 --> 00:36:09,400 Speaker 1: thank you so much for being on and have a 698 00:36:09,440 --> 00:36:12,640 Speaker 1: wonderful day. Thank you. It was my pleasure and hopefully 699 00:36:12,680 --> 00:36:15,879 Speaker 1: a little bit useful for women as they navigate their 700 00:36:15,880 --> 00:36:20,560 Speaker 1: forties and stay healthy. It will be all right. Yes, 701 00:36:20,960 --> 00:36:24,880 Speaker 1: that was great, Thank you, Sarah. So this question comes 702 00:36:24,880 --> 00:36:27,120 Speaker 1: from her listener, who says that she has been listening 703 00:36:27,200 --> 00:36:29,680 Speaker 1: to off the clock while tidying up in the kitchen. 704 00:36:29,800 --> 00:36:33,359 Speaker 1: So gold star for listening to my books while multitasking well. 705 00:36:33,400 --> 00:36:35,160 Speaker 1: Her husband was putting the kids to bed and she 706 00:36:35,280 --> 00:36:39,360 Speaker 1: was contemplating opportunities to linger, and soon after she was 707 00:36:39,400 --> 00:36:41,560 Speaker 1: coaxing her fiercely independent two and a half year old 708 00:36:41,600 --> 00:36:43,520 Speaker 1: sound go to the potty, find the right teddy, climb 709 00:36:43,560 --> 00:36:47,080 Speaker 1: into bed, And during this frustrating process, was acutely aware 710 00:36:47,080 --> 00:36:50,280 Speaker 1: of how many times she was saying quickly. She's always 711 00:36:50,280 --> 00:36:52,040 Speaker 1: been conscious of how she speaks to her kids. But 712 00:36:52,080 --> 00:36:54,080 Speaker 1: the note, seeing that the more impatient she was to 713 00:36:54,080 --> 00:36:56,799 Speaker 1: get him into bed, the Mary would resist. She's keen 714 00:36:56,800 --> 00:36:59,680 Speaker 1: to get on top of her quickly habit. The obvious 715 00:36:59,719 --> 00:37:02,960 Speaker 1: solution is to start bedtime early so there's less need 716 00:37:03,000 --> 00:37:05,640 Speaker 1: to rush, but she says, in a practical sense, there 717 00:37:05,680 --> 00:37:08,640 Speaker 1: will always be times in life when I do need 718 00:37:08,680 --> 00:37:11,160 Speaker 1: to keep things moving for various reasons, and I hope 719 00:37:11,200 --> 00:37:13,200 Speaker 1: the kids can learn to respect that so I started 720 00:37:13,200 --> 00:37:15,960 Speaker 1: thinking about how I talk about time in general, and 721 00:37:16,000 --> 00:37:19,200 Speaker 1: she is curious about how we talk to our kids 722 00:37:19,239 --> 00:37:22,640 Speaker 1: about time, thinking about how they spend it, the responsibility 723 00:37:22,680 --> 00:37:27,080 Speaker 1: to others in terms of punctuality, respecting other people's time choices. 724 00:37:27,920 --> 00:37:30,560 Speaker 1: So what do we do to talk to our kids 725 00:37:30,600 --> 00:37:33,359 Speaker 1: about time? I'm mostly going to leave this one to you. 726 00:37:33,480 --> 00:37:35,399 Speaker 1: I don't feel like I have this mastered at all. 727 00:37:35,760 --> 00:37:37,879 Speaker 1: I will say, there's certainly a countdown when we're leaving 728 00:37:37,880 --> 00:37:40,080 Speaker 1: for school, Cameron, we have to leave in six minutes, Cameron, 729 00:37:40,120 --> 00:37:43,719 Speaker 1: we have to leave in three minutes, et cetera. But no, 730 00:37:43,800 --> 00:37:45,720 Speaker 1: I don't have great answers. I will say I enjoy 731 00:37:46,280 --> 00:37:48,640 Speaker 1: Annabelle and I sometimes will sit down with our planners, 732 00:37:48,680 --> 00:37:50,759 Speaker 1: and I think using a planner is a great way 733 00:37:50,800 --> 00:37:52,960 Speaker 1: to get a little bit of a grasp on you know, 734 00:37:53,000 --> 00:37:54,840 Speaker 1: what time you have available and how you might like 735 00:37:54,880 --> 00:37:57,960 Speaker 1: to use that. But what is she planning? I'm curious 736 00:37:58,000 --> 00:38:00,399 Speaker 1: what is she putting in her planner? Then to plan 737 00:38:00,480 --> 00:38:03,920 Speaker 1: her entire day? She'll be like, checkbox, make bed, checkbox, 738 00:38:04,000 --> 00:38:09,080 Speaker 1: eat breakfast, checkbox. That's good. I'm like, oh, you learned 739 00:38:09,080 --> 00:38:15,440 Speaker 1: from mommy. Okay, it's really cute. It's really really cute. Yeah, 740 00:38:15,640 --> 00:38:18,040 Speaker 1: So she gad plans for next year. She has her 741 00:38:18,080 --> 00:38:20,440 Speaker 1: own Hobunichi. So we've talked about like, what are you 742 00:38:20,440 --> 00:38:22,480 Speaker 1: going to put in there? I need to help her 743 00:38:22,480 --> 00:38:25,359 Speaker 1: with the weekly spreads those are oh yeah, I'm sure 744 00:38:25,360 --> 00:38:27,360 Speaker 1: we could all use her help with our weekly spreads. 745 00:38:27,400 --> 00:38:31,800 Speaker 1: It's exciting for Annabel that she has professional consultation options 746 00:38:31,840 --> 00:38:35,319 Speaker 1: in her own home and so young. Yeah, I think 747 00:38:35,360 --> 00:38:41,280 Speaker 1: talking to children about time is just an interesting concept. 748 00:38:41,280 --> 00:38:45,040 Speaker 1: I mean, little kids have very limited concept of time 749 00:38:45,320 --> 00:38:49,000 Speaker 1: in general. They're very much in the present and that's fine, 750 00:38:49,560 --> 00:38:52,759 Speaker 1: you know, that's what they are. That's obviously challenging when 751 00:38:52,760 --> 00:38:55,160 Speaker 1: you need to move them from the present to something 752 00:38:55,160 --> 00:38:57,879 Speaker 1: that is happening in the future. And I know that 753 00:38:57,960 --> 00:39:00,000 Speaker 1: one of the things during this pandemic that has been 754 00:39:00,080 --> 00:39:03,600 Speaker 1: sort of you know, easier in many ways for many 755 00:39:03,600 --> 00:39:05,560 Speaker 1: people is there's less of that rushing to get to 756 00:39:05,640 --> 00:39:10,080 Speaker 1: some time specific thing that you know, if baseball is canceled, 757 00:39:10,680 --> 00:39:13,320 Speaker 1: gymnastics has canceled, schools, there's no rushing to get in 758 00:39:13,360 --> 00:39:16,759 Speaker 1: the car for anything, And in some ways that makes 759 00:39:16,760 --> 00:39:20,239 Speaker 1: life a lot more relaxing, even if it introduces for 760 00:39:20,840 --> 00:39:25,560 Speaker 1: different challenges as well, so you know, always being I 761 00:39:25,640 --> 00:39:28,200 Speaker 1: like the countdown, you know, to say, well, we've decided 762 00:39:28,200 --> 00:39:29,719 Speaker 1: that we wanted to go do this, and you know 763 00:39:29,760 --> 00:39:31,799 Speaker 1: you're gonna have fun doing this, and so in I'm 764 00:39:31,800 --> 00:39:33,719 Speaker 1: giving you a five minute warning and so then they 765 00:39:33,800 --> 00:39:36,120 Speaker 1: can you know, they're not yanked out of whatever fun 766 00:39:36,239 --> 00:39:40,560 Speaker 1: thing they were absorbed in. Quite so immediately talking with 767 00:39:40,600 --> 00:39:43,120 Speaker 1: little kids, obviously setting routines like first we do this, 768 00:39:43,239 --> 00:39:46,000 Speaker 1: then we do this. You know, first we eat breakfast, 769 00:39:46,000 --> 00:39:48,000 Speaker 1: and then we brush our teeth, and then we put 770 00:39:48,000 --> 00:39:50,040 Speaker 1: our shoes on, and then we get in the car, 771 00:39:50,560 --> 00:39:53,480 Speaker 1: or you know, at night, first we try the bathroom, 772 00:39:53,560 --> 00:39:55,920 Speaker 1: then we wash our face and whatever like, just so 773 00:39:55,960 --> 00:40:00,719 Speaker 1: they understand how one thing happens after another. I think 774 00:40:00,719 --> 00:40:03,600 Speaker 1: as kids get a little bit older, you can start 775 00:40:03,640 --> 00:40:06,480 Speaker 1: introducing the idea more of thinking about the future and 776 00:40:06,520 --> 00:40:10,680 Speaker 1: sort of planning your process toward that. You know, certainly, 777 00:40:10,680 --> 00:40:14,000 Speaker 1: if kids start getting weekly assignments, that's a really good 778 00:40:14,040 --> 00:40:16,880 Speaker 1: opportunity to say like, oh, well, your teacher wants you 779 00:40:16,880 --> 00:40:18,560 Speaker 1: to have it in on Friday, when would you like 780 00:40:18,640 --> 00:40:21,360 Speaker 1: to do it? And let them consider the various options 781 00:40:21,360 --> 00:40:23,719 Speaker 1: and if they want to do it Friday morning, I 782 00:40:23,760 --> 00:40:26,200 Speaker 1: mean you can let them try why not, right, like 783 00:40:26,320 --> 00:40:29,520 Speaker 1: let them figure it out that they're then rushing and 784 00:40:29,560 --> 00:40:32,120 Speaker 1: like coming in late and be draggled, or I mean, 785 00:40:32,120 --> 00:40:34,719 Speaker 1: this is a learning experience that then helps them as 786 00:40:34,760 --> 00:40:36,960 Speaker 1: they get to grades where it actually matters more that 787 00:40:37,040 --> 00:40:40,080 Speaker 1: you can map out your time, you know, for things 788 00:40:40,120 --> 00:40:42,720 Speaker 1: that happen in the future. You know, again smaller children 789 00:40:42,760 --> 00:40:46,520 Speaker 1: talking about how many sleeps there are until we leave 790 00:40:46,560 --> 00:40:48,640 Speaker 1: for that trip. They want to know what they can 791 00:40:48,680 --> 00:40:52,280 Speaker 1: expect in the future. But actually, for my eldest, for Jasper, 792 00:40:52,280 --> 00:40:55,560 Speaker 1: we've had a lot of conversations about not wishing time away. 793 00:40:56,200 --> 00:40:57,920 Speaker 1: Like sometimes he's very much like, well, I can't wait 794 00:40:58,000 --> 00:41:00,399 Speaker 1: till this, right, you know, only eight more days until 795 00:41:00,400 --> 00:41:03,320 Speaker 1: we're going to do this. It's like, well, yes, that's true, 796 00:41:03,320 --> 00:41:06,040 Speaker 1: and we are looking forward to this and in eight days, 797 00:41:06,080 --> 00:41:09,399 Speaker 1: but there could be fun stuff in this upcoming eight 798 00:41:09,480 --> 00:41:12,160 Speaker 1: days and we don't want to necessarily lose sight of 799 00:41:12,160 --> 00:41:16,279 Speaker 1: that in our rush to get to this thing. So 800 00:41:16,440 --> 00:41:18,680 Speaker 1: you know, that's one of the things I've been trying 801 00:41:18,719 --> 00:41:22,680 Speaker 1: to talk about. And you know, I think time management 802 00:41:22,760 --> 00:41:25,080 Speaker 1: is something everyone sort of has to learn for themselves. 803 00:41:25,120 --> 00:41:28,080 Speaker 1: I mean, you can offer guidance and help kids learn 804 00:41:28,080 --> 00:41:30,680 Speaker 1: to think about how they think through their time and 805 00:41:30,719 --> 00:41:32,560 Speaker 1: how much time stuff is probably going to take and 806 00:41:32,600 --> 00:41:36,239 Speaker 1: when they probably can get to it. But until you 807 00:41:36,280 --> 00:41:39,080 Speaker 1: are in charge of your own time fully, it's sort 808 00:41:39,080 --> 00:41:41,960 Speaker 1: of hard to absorb many of these lessons, and many 809 00:41:42,000 --> 00:41:47,480 Speaker 1: adults are not good at them. No, that's true, not 810 00:41:47,520 --> 00:41:50,480 Speaker 1: saying that adults learn them either, So there you go, 811 00:41:51,600 --> 00:41:54,520 Speaker 1: but I agree that, Yeah, we spend a lot of 812 00:41:54,600 --> 00:41:56,440 Speaker 1: time off and yelling at kids to hurry it up, 813 00:41:56,920 --> 00:42:00,160 Speaker 1: and it might be good to think about that we 814 00:42:00,239 --> 00:42:02,960 Speaker 1: do all right, Well, this has been best of both worlds. 815 00:42:03,040 --> 00:42:06,160 Speaker 1: Sarah has interviewed doctor Laura Erdman and ob g y 816 00:42:06,360 --> 00:42:08,480 Speaker 1: N and we will be back next week with more 817 00:42:08,520 --> 00:42:12,680 Speaker 1: on making work and life fit together. Thanks for listening. 818 00:42:12,920 --> 00:42:16,040 Speaker 1: You can find me Sarah at the shoebox dot com 819 00:42:16,160 --> 00:42:19,920 Speaker 1: or at the Underscore Shoebox on Instagram, and you can 820 00:42:19,960 --> 00:42:24,200 Speaker 1: find me Laura at Laura vandercam dot com. This has 821 00:42:24,239 --> 00:42:27,560 Speaker 1: been the best of both Worlds podcasts. Please join us 822 00:42:27,560 --> 00:42:30,960 Speaker 1: next time for more on making work and life work together.