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Speaker 1: Welcome to the Therapy for Black Girls Podcast, a weekly

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Speaker 1: conversation about mental health, personal development, and all the small

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Speaker 1: decisions we can make to become the best possible versions

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Speaker 1: of ourselves. I'm your host, Doctor Joy Harden Bradford, a

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Speaker 1: licensed psychologist in Atlanta, Georgia. For more information or to

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Speaker 1: find a therapist in your area, visit our website at

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Speaker 1: Therapy for Blackgirls dot com. While I hope you love

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Speaker 1: listening to and learning from the podcast, it is not

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Speaker 1: meant to be a substitute for a relationship with a

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Speaker 1: licensed mental health professional. Hey y'all, thanks so much for

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Speaker 1: joining me for session three nineteen of the Therapy for

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Speaker 1: Black Girls podcast. Welcome right into our conversation. After a

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Speaker 1: word from our sponsors, which friend are you? And your

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Speaker 1: sister circle? Are you the wallflower, the peacemaker, the firecracker

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Speaker 1: or the leader? Take the quiz at Sisterhoodhels dot com

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Speaker 1: slash quiz to find out, and then make sure to

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Speaker 1: grab your copy of Sisterhood Heels to find out more

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Speaker 1: about how you can be a better friend and how

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Speaker 1: your circle can do a better job of supporting you.

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Speaker 1: Order yours today at Sisterhoodheels dot com. Last week, we

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Speaker 1: started a very important conversation to help with demystifying what

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Speaker 1: we know about menopause. Joining me for part two of

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Speaker 1: this conversation is doctor Chrissy Freeman. Doctor Freeman is a

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Speaker 1: second year OBGYN resident physician currently working in California. Throughout

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Speaker 1: her education and training, she has demonstrated a passion in

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Speaker 1: dedication to advancing reproductive health and insuring equitable care in

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Speaker 1: underserved communities. In addition to serving her community, doctor Freeman

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Speaker 1: utilizes social media to document the highs and lows of

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Speaker 1: her journey through medicine and hopes to dedicate her career

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Speaker 1: to improving Black maternal health outcomes as a high risk

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Speaker 1: obstetric specialist. In our conversation, doctor Freeman and I explore

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Speaker 1: common misconceptions created around menopause, how menopausal symptoms can show

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Speaker 1: up differently for Black women, and what health risks menopausal

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Speaker 1: individuals should be looking out for. Please note that the

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Speaker 1: information doctor Freeman provided in this conversation is not to

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Speaker 1: be considered medical advice, and any opinions shared are hers

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Speaker 1: and do not reflect those of our employer or institution.

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Speaker 1: If something resonates with you while enjoying our conversation. Please

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Speaker 1: share it with us on social media using the hashtag

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Speaker 1: TVG in session or join us so we're in the

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Speaker 1: sister circle. To talk more about the episode, you can

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Speaker 1: join us at community dot therapyfro blackgirls dot com. Here's

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Speaker 1: our conversation. Thank you so much for joining us today,

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Speaker 1: doctor Freeman.

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Speaker 2: Thank you for having me.

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Speaker 1: Very excited to hear from you. So I want to

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Speaker 1: start with having you try to break it all the

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Speaker 1: way down for us because we are digging into all

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Speaker 1: things menopause today. So what is menopause and who does

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Speaker 1: it impact?

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Speaker 3: Yeah, you know, this is such an important conversation as

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Speaker 3: menopause is something that will eventually affect anyone with functioning ovaries,

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Speaker 3: which is half of the world's population. And so we

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Speaker 3: define menopause as the cessation or lack of menstrual periods

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Speaker 3: for twelve months, and this signifies the end of ovulatory

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Speaker 3: function of the ovaries, so the ability to release an

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Speaker 3: egg every month. And because the function of the ovaries

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Speaker 3: is starting to decline, this results in lower estrogen levels

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Speaker 3: throughout the body, which gives a lot of the common

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Speaker 3: symptoms of menopause that we hear about.

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Speaker 1: Got it, And so is estrogen the only player and

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Speaker 1: all of these symptoms that we hear because I think

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Speaker 1: we'll get into this, but there are like so many

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Speaker 1: collections of symptoms, and so are all of these things

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Speaker 1: directly connected to estrogen.

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Speaker 2: Most of them?

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Speaker 3: Yes, there are multiple different hormones that play a role

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Speaker 3: in the mental cycle and regulation of that, but most

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Speaker 3: of the symptoms that women experience are primarily due to

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Speaker 3: lower estrogen levels.

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Speaker 1: Got it okay? So can you go into some of

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Speaker 1: these symptoms and side effects that we experience as a

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Speaker 1: part of menopause.

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Speaker 2: Absolutely. So.

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Speaker 3: Some of these symptoms happen even before the final menstrual period,

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Speaker 3: so anywhere from one to four years before that very

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Speaker 3: last period, women may start to notice these symptoms. So

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Speaker 3: some of those could be irregular periods, So variation in

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Speaker 3: how long periods normally last if it was four days

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Speaker 3: before and now maybe it's seven, and changes in the

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Speaker 3: quantity of bleeding, so some patients will say, oh, I'm

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Speaker 3: having more bleeding than I used to, or actually, my

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Speaker 3: periods are super light when they were heavier. Women may

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Speaker 3: also notice that the time interval in between their periods

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Speaker 3: is changing, so for some women it gets longer where

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Speaker 3: there's months in between periods, or for some people it

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Speaker 3: gets shorter where they're like, oh, I've had two periods

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Speaker 3: in this one month, what's going on. Another big one

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Speaker 3: is what we call vasomotor symptoms, so hot flashes night sweats,

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Speaker 3: which are very very common, and over eighty percent of

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Speaker 3: people going through perimenopause and menopause will experience these hot

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Speaker 3: flashes are night sweats at some point, and this is

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Speaker 3: that sudden sensation of heat in the chest and in

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Speaker 3: the face that progresses to the entire bodies. Some patients

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Speaker 3: experience palpitations like heart beating, fast sweating, chills, anxiety, and

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Speaker 3: this is because the lack of estrogen in the body

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Speaker 3: is actually causing changes in how your body regulates temperature.

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Speaker 3: A couple other ones are changes in sleep patterns and

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Speaker 3: sleep disservances, and so hot flashes are really common at

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Speaker 3: nighttime and so that can definitely disrupt sleep for patients.

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Speaker 3: And then one that I think is really important that

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Speaker 3: a lot of people don't talk about is actually mood

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Speaker 3: changes and depression. And so for women who have a

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Speaker 3: history of mental health disorders or mood disorders, going through

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Speaker 3: menopause can actually make those worse or even for some

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Speaker 3: people make those manifests for the first time.

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Speaker 1: Wow, thank you so much for that, Doctor Freeman. You know,

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Speaker 1: I feel like this is probably really difficult to tease

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Speaker 1: out because so much of what you've shared as symptoms

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Speaker 1: could be connected to like all kinds of things. Right,

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Speaker 1: And you mentioned that sometimes even between one and four

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Speaker 1: years before we actively say it's menopause, somebody might be

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Speaker 1: experiencing these symptoms. So at what point would you talk

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Speaker 1: with your healthcare provider about what you're experiencing, Like, how

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Speaker 1: might you even connect some of these symptoms to possible

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Speaker 1: menopause or pre menopause? Right, is another thing that is

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Speaker 1: talked about.

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Speaker 3: Yeah, I think as soon as someone notices changes in

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Speaker 3: their body or their periods, I think that's always a

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Speaker 3: good time to start a conversation, just so that your

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Speaker 3: health care provider knows what's going on and can keep

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Speaker 3: track of things over time. I have some patients who

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Speaker 3: actually keep a blog or diary of their symptoms so

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Speaker 3: that we can come up with a plan. So for

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Speaker 3: some patients, they may have symptoms only at night time,

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Speaker 3: and so that's what's most bothersome to them. Some patients

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Speaker 3: have symptoms all the time, and so we're able to

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Speaker 3: tease those out and come up with a treatment plan

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Speaker 3: that works for different people. I think it's important to

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Speaker 3: have these conversations even if you're not sure, because it's

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Speaker 3: important to know what's normal and what's abnormal as your

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Speaker 3: body is going through these changes. Like we just talked

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Speaker 3: about all of those symptoms, but some of those symptoms

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Speaker 3: overlap with other conditions like you just mentioned, and so

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Speaker 3: it's important to start to have those conversations with your

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Speaker 3: healthcare provider so that if this is menopause, we can

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Speaker 3: normalize that, we can work through that, we can treat it.

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Speaker 3: But if this is something else, we also need to

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Speaker 3: be addressing that.

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Speaker 2: And one of the things.

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Speaker 3: That comes up for me when thinking about having these

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Speaker 3: conversations with patients and knowing what's normal, is that if

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Speaker 3: a patient hasn't had a period for several months at

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Speaker 3: a time, especially if they've hit that twelve month mark,

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Speaker 3: and bleeding returns, that's actually a very worrisome sign and

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Speaker 3: that's typically not normal, and so you should absolutely go

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Speaker 3: to the doctor seek medical advice if something like that happens,

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Speaker 3: because bleeding after menopause is rarely ever normal, And there

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Speaker 3: can be many explanations for postmenopausal bleeding, but the biggest

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Speaker 3: concern is actually for uterine cancer, which is the most

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Speaker 3: common gynecologic cancer and one of the most common cancers

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Speaker 3: in way overall. And so this matters, right, this is

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Speaker 3: a therapy for Black girls podcast. So why is postman

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Speaker 3: a pausit of bleeding so important? Especially for black women?

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Speaker 3: And the reason is that Black women are more likely

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Speaker 3: to be diagnosed with uterine cancer at advanced stages and

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Speaker 3: are more likely to have aggressive forms of uterine cancer.

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Speaker 3: And so it's important to make sure you have a

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Speaker 3: good relationship with a healthcare provider so that you can know, Okay,

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Speaker 3: this is normal, this is falling outside of the realm

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Speaker 3: of normal. Do we need to take more steps? Do

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Speaker 3: we need to do more work up so that you know,

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Speaker 3: we can try to come back these health disparities that

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Speaker 3: we see in our population all the time.

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Speaker 1: Thank you for sharing that, doctor Freeman. I was not

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Speaker 1: aware that are there other signs of uterine cancer that

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Speaker 1: you think the community should be aware of.

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Speaker 3: Absolutely, some patients may have like pelvic pain or pelvic pressure.

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Speaker 3: Some patients might even feel a mass in their lower abdomen,

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Speaker 3: something that's new that wasn't there before. Any abnormal vaginal

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Speaker 3: discharge or abnormal bleeding should always be investigated. Sometimes if

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Speaker 3: patients present and share that they, you know, have had

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Speaker 3: postmenopausitive bleeding. Sometimes we'll start with an ultrasound to just

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Speaker 3: take a look at the uterus, take a look at

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Speaker 3: the ovaries, all the pelvic organs, to make sure, you know,

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Speaker 3: everything is normal. Sometimes we'll actually just jump to a biopsy,

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Speaker 3: which is taking a sample of some of the tissue

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Speaker 3: inside the uters to actually get a diagnosis and figure

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Speaker 3: out exactly what's going on.

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Speaker 1: Got it? So, you know, so much of it feels

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Speaker 1: like what happens with menopause, But I think in general

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Speaker 1: what happens with women's bodies is like shared in secrecy, right,

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Speaker 1: Like we are kind of sharing behind closed doors, and

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Speaker 1: you know, it feels like some of that promotes a

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Speaker 1: lot of misinformation. Can you talk about that as it

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Speaker 1: relates to menopause, and like how that sometimes prevents us

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Speaker 1: from getting the correct information.

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Speaker 2: Absolutely.

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Speaker 3: I remember growing up and watching all these TV shows

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Speaker 3: and movies about well young girls going through puberty and

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Speaker 3: starting their periods for the first time, and it was

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Speaker 3: always introduced as this narrative of you're a woman now

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Speaker 3: or welcome to womanhood. And the concern that this brings

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Speaker 3: up for me is that so much of our identities

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Speaker 3: as women seem to be tied into our ability to menstruate,

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Speaker 3: our ability to conceive, And so as women go through

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Speaker 3: menopause and lose that natural ability, what does this mean

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Speaker 3: for their identity?

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Speaker 2: Right?

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Speaker 3: And so I think there's a lot of stigma surrounding

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Speaker 3: these hormonal transitions that are completely normal and completely natural,

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Speaker 3: but it puts pressure on women to redefine their identity,

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Speaker 3: rediscover themselves when they've had such a significant change. And

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Speaker 3: you know, I think so much of women's health itself

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Speaker 3: is focused on reproductive age women. We're comfortable talking about

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Speaker 3: sexual health, contraception periods, fertility, birth experiences, but there's not

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Speaker 3: as much formal education on menopause and the postmenopausal period.

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Speaker 3: And that's not just for the general population, that's even

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Speaker 3: for healthcare professionals. Not many of us learn about menopause,

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Speaker 3: how to diagnose, how to treat, what treatment options are

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Speaker 3: appropriate for different people, And so I think there's just

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Speaker 3: a lack of information, which of course will always lead

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Speaker 3: to misinformation or assumptions throughout this period.

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Speaker 1: What are some of the main misconceptions you feel like

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Speaker 1: you've heard or that you have to come back in

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Speaker 1: your own office around menopause.

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Speaker 3: I think one of the biggest ones is that, like

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Speaker 3: I mentioned that bleeding after menopause is okay. I remember

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Speaker 3: having a patient who came in and was actually diagnosed

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Speaker 3: with pretty bad uterine cancer, and she was like, I

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Speaker 3: was going to the doctor multiple times and he told me,

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Speaker 3: since I had a history of fibroids, that this bleeding

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Speaker 3: was okay, and it was probably because of my fibroids.

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Speaker 3: And given that fibroids are so common in black women,

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Speaker 3: I wonder how many women are actually hearing this narrative that, oh,

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Speaker 3: you have fibroids, so that's going to make you bleed

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Speaker 3: in menopause. When fibroids are hormonally responsive, they're responsive to estrogen,

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Speaker 3: and so if estrogen levels are lower after menopause, fibroids

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Speaker 3: shouldn't be causing bleeding. Another thing is just thinking about

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Speaker 3: the mood changes that come along with menopause, and some

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Speaker 3: patients are like, I've never been depressed before. Why am

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Speaker 3: I feeling sad? Why am I crying? Why are all

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Speaker 3: these different changes happening? And you know, I think it's

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Speaker 3: just really important to normalize the very broad range of

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Speaker 3: experiences that people have, the broad range of severity of

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Speaker 3: different symptoms, so that you know, there can just be

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Speaker 3: a common understanding about the changes that are going on

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Speaker 3: in women's bodies.

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Speaker 1: You know, I'm curious because you mentioned so much of

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Speaker 1: the identity that a lot of your patients have is

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Speaker 1: connected to this whole idea of menstruation and conceiving and

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Speaker 1: fertility and all those things, and then once menopause hits,

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Speaker 1: then there is a different conversation around well, who am I.

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Speaker 1: Can you share a little bit about maybe some of

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Speaker 1: the themes that have come up with your patients or

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Speaker 1: different kinds of conversations you have with them around identity

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Speaker 1: and how that changes.

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Speaker 3: Absolutely, I feel like I've talked to patients where let's say,

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Speaker 3: for example, a patient is having postmenopausal bleeding, and we're

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Speaker 3: having these conversations about the possibilities and what if this,

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Speaker 3: what if that. I think so many women hold on

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Speaker 3: to the idea of maintaining their uterus, for example, because

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Speaker 3: that is how they carried their children. That is what

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Speaker 3: gave them this identity that goes along with menstruation and

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Speaker 3: conception and all the things we're talking about. And so

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Speaker 3: I think when we get into concerns with bleeding, concerns

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Speaker 3: with menopause changes in the body, I think it's very

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Speaker 3: hard sometimes to have these conversations about whether hysterectomy is recommended,

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Speaker 3: how to manage these different conditions. You know, sometimes we

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Speaker 3: even offer add back hormone therapy for some patients, and

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Speaker 3: just getting patients to come to terms with the fact

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Speaker 3: that this is a natural experience that can be uncomfortable,

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Speaker 3: that can be very disturbing and impacting people's quality of life,

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Speaker 3: but that it's something that we can help with and

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Speaker 3: it doesn't have to consume so much of your life

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Speaker 3: and so much of your identity as having this huge

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Speaker 3: change and this drastic difference in the way that you

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Speaker 3: perceive and relate to your own self as a woman.

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Speaker 1: For those who aren't familiar, doctor Freeman, can you say

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Speaker 1: what a hysterectomy is and when it might be appropriate

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Speaker 1: for a patient.

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Speaker 3: Yeah, So, hysterectomy is the removal of the uterus, sometimes

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Speaker 3: the cervix. So there's different types. Some people have total hysterectomies,

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Speaker 3: which removes the uterus, the cervix, the Filippian tubes. Some

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Speaker 3: people also have their ovaries removed. Some people leave the

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Speaker 3: cervix in place. So there's different varieties, but there's various

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Speaker 3: reasons that hysterectomies can be recommended for some patients who

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Speaker 3: who are done with their reproductive years and they're having

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Speaker 3: concerns about heavy bleeding from vibroids, for example, that's a

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Speaker 3: very common reason that hysterectomies are performed.

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Speaker 2: And then when we're.

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Speaker 3: Thinking about the menopausal transition postmenopausal bleeding, if there's any

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Speaker 3: concern for developing uterine cancer, depending on what stage or

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Speaker 3: how significant the concern is, there could also be a

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Speaker 3: recommendation to have the uters removed at that time for

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Speaker 3: complete staging and diagnosis of whatever concern there is.

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Speaker 1: So, can you talk a little bit about the treatments

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Speaker 1: doctor Freeman you mentioned briefly. Are you treating like a

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Speaker 1: collection of these symptoms? Is there some medication that kind

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Speaker 1: of treats multiple symptoms? What does treatment typically look like?

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Speaker 3: Yeah, So treatment varies from person to person depending on

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Speaker 3: what they're experiencing and how bad things are and so

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Speaker 3: we can kind of go symptom by symptoms. So for

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Speaker 3: the hot flashes or the vasomotor symptoms, some patients try

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Speaker 3: behavior modification. It's like carrying a fan with them, wearing

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Speaker 3: multiple layers of clothes, things that can be taken off

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Speaker 3: to cool off, avoiding spicy foods or other triggers. For

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Speaker 3: hot flashes. There are also medications that can be used,

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Speaker 3: so antidepressants, some anti seizure medications, various different medications that

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Speaker 3: can be used to treat these hot flashes. We know

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Speaker 3: that antidepressants are actually one of the most effective treatments

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Speaker 3: for hot flashes, and that also doubles if a person

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Speaker 3: is experiencing mood symptoms or depressive symptoms, so that can

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Speaker 3: treat both. Another very common symptom that we haven't mentioned

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Speaker 3: yet is actually vaginal symptoms, so it's called genito urinary

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Speaker 3: syndrome of menopause or volvo vaginal atrophy. That's a big words,

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Speaker 3: but a lot of patients, because of the lack of estrogen,

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Speaker 3: may experience vaginal dryness. Patients have described it as like

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Speaker 3: a sand paper feeling to the vagina where the tissue

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Speaker 3: gets very thin and a lot of patients try over

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Speaker 3: the counter things for this, so things that you might

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Speaker 3: have your kitchen, like olive oil, coconut oil, those can

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Speaker 3: be great lubricants for the vagina. They are also different

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Speaker 3: over the counter brands that are sold. But there's also

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Speaker 3: estrogen creams that can be used to treat vaginal jyness.

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Speaker 3: And the most effective treatment for all of these things,

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Speaker 3: for any of the symptoms of menopause is actual hormone replacement,

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Speaker 3: which has been controversial over the past several years. There's

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Speaker 3: always risks and benefits to anything that we do in medicine,

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Speaker 3: and so I think if a patient is considering hormone replacement,

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Speaker 3: they definitely need to have a conversation with their physician

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Speaker 3: about what other medical conditions they have, because there are

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Speaker 3: some medical conditions that make hormone replacement a little more risky,

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Speaker 3: such as having pre existing heart disease, history of stroke,

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Speaker 3: history of certain types of cancers, history of blood clots.

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Speaker 3: These are reasons is that we might not recommend hormone

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Speaker 3: replacement therapy for a patient. And there's also some thought

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Speaker 3: about how long a patient has been going through menopause.

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Speaker 3: If a patient is past a certain point, so they've

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Speaker 3: been ten plus years past their last menstrual period. That

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Speaker 3: can also make it higher risk for using hormone replacement.

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Speaker 3: It's very nuanced, right, there's no one size fits all,

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Speaker 3: there's no one treatment fits all. Everything is variable based

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Speaker 3: on a person, based on what symptoms they're experiencing, how

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Speaker 3: bad those symptoms are, when those symptoms are happening. Just

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Speaker 3: everybody's different, and so it's always an opportunity to kind

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Speaker 3: of have that conversation. Make sure you're keeping that journal

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Speaker 3: or that diary so that we can address your concerns

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Speaker 3: and make sure we're meeting your needs to improve your

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Speaker 3: quality of life.

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Speaker 1: More from our conversation after the break, Doctor Freeman, can

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Speaker 1: you say more about what hormone replacement therapy is and

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Speaker 1: why it has been controversial.

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Speaker 3: Yeah, for sure, Hormone replacement therapy is actually giving your

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Speaker 3: body back the hormones that are not being regulated because

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Speaker 3: the ovaries have shut down their function. And the main

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Speaker 3: two hormones are estrogen and progesterone. Estrogen being the primary

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Speaker 3: driver because as we've talked about, estrogen is the main

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Speaker 3: influence for a lot of these symptoms that women experience.

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Speaker 3: The reason we use progesterone for some patients is that

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Speaker 3: progesterone protects the uterus, and so if a patient still

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Speaker 3: has their uterus, it's important that we give progesterone to

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Speaker 3: keep the inside lining of the uterus quiet so that

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Speaker 3: it doesn't overgrow and doesn't turn into something more concerning

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Speaker 3: like pre cancer or cancer. And so for patients who

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Speaker 3: actually don't have their uterus anymore, they can have estrogen only.

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Speaker 3: And these hormone replacements can be done in multiple different ways.

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Speaker 3: There are pill forms, there is local forms, So like

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Speaker 3: I was mentioning the estrogen cream for the vagina, that's

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Speaker 3: something that goes directly into the vagina and there's not

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Speaker 3: very much systemic absorption, so it doesn't go through the

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Speaker 3: rest of the body Versus pill forms or estrogen patches

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Speaker 3: are very common, and so there's different doses of these medications.

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Speaker 3: There's different ways of taking them, and depending on one's symptoms.

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Speaker 3: If it's global symptoms like I'm having the hot flashes,

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Speaker 3: I'm having dryness, I'm having all the things, maybe a

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Speaker 3: patient wants to do more systemic therapy, things that are

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Speaker 3: going through the whole body to hit multiple systems, versus

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Speaker 3: if a patient is like my hot flashes aren't that bad,

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Speaker 3: but I'm really bothered by my vaginal symptoms. Then we

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Speaker 3: can do something more local, like vaginal estrogen cream.

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Speaker 1: I was surprised to hear you say that antidepressants are

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Speaker 1: one of the kind of goal standard in some ways

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Speaker 1: treatments for the hot flashes.

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Speaker 3: Why is that, you know, it's a really good question.

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Speaker 3: There is some belief that the lack of estrogen alters

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Speaker 3: the serotonin levels in the body, and so a specific

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Speaker 3: class of antidepressants called selective serotonin reuptake inhibitors or Ssriyes,

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Speaker 3: those are one of the most effective treatments, and so

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Speaker 3: for some patients that's something that you know, we can

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Speaker 3: easily start and try. We can start at low doses

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Speaker 3: and uptie trade or increase the dose as needed to

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Speaker 3: target symptoms. And like I mentioned, for some patients who

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Speaker 3: are actually experiencing depressive symptoms or are having mood changes

385
00:22:30,560 --> 00:22:34,399
Speaker 3: associated with their menopause transition, this can kill two birds

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Speaker 3: with one stone, got it?

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Speaker 1: Thank you for that. The other thing though we often

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Speaker 1: hear with just working with clients who may be working

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Speaker 1: with a psychiatrist or somebody with SSRIs is that then

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Speaker 1: the downside is sometimes sexual side effects, right, so there

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Speaker 1: may be loss of interest. I would imagine that you're

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Speaker 1: trying to balance all of those things at the same time.

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Speaker 3: Absolutely, absolutely, it's such a delicate balance because it's funny

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Speaker 3: with medicine, right, Like you treat one thing and then

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Speaker 3: it causes these.

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Speaker 2: Other side effects that you didn't have to manage.

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Speaker 3: So it's challenging, and I think that's why it's important

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Speaker 3: for patients to not be discouraged, right, Like, if you

399
00:23:10,040 --> 00:23:13,240
Speaker 3: try one thing and it's not working for you, try

400
00:23:13,240 --> 00:23:13,800
Speaker 3: something else.

401
00:23:14,280 --> 00:23:15,000
Speaker 2: There's so many.

402
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Speaker 3: Different options for managing these symptoms, and so you know,

403
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Speaker 3: I've had a patient who's like, Okay, I want to

404
00:23:21,240 --> 00:23:25,280
Speaker 3: try the SSRI first, but if that's not working, then

405
00:23:25,359 --> 00:23:29,080
Speaker 3: can I try something. Absolutely, there's no one size fits all,

406
00:23:29,640 --> 00:23:32,440
Speaker 3: and there are so many ways to manage these symptoms.

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Speaker 1: So you've said that there needs to be like the

408
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Speaker 1: absence of a cycle for twelve months before like menopause

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Speaker 1: is officially declared. But do you see like a going

410
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Speaker 1: back to feeling normal post menopause or is it like

411
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Speaker 1: a new normal? Can you talk about like when we

412
00:23:50,160 --> 00:23:52,760
Speaker 1: can expect it, Like will you ever feel like your

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Speaker 1: old self? So to speak? After menopause.

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Speaker 3: Yeah, so that's a really tough one because again, everybody's different.

415
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Speaker 3: I feel like I keep saying it, everybody's different. For

416
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Speaker 3: some patients, these symptoms might persist for five ten years.

417
00:24:08,200 --> 00:24:11,040
Speaker 3: For some patients, they actually don't have symptoms that are

418
00:24:11,040 --> 00:24:14,760
Speaker 3: that bad. And so we see different trajectories for how

419
00:24:14,800 --> 00:24:19,280
Speaker 3: people are experiencing their menopausal symptoms and what's actually happening

420
00:24:19,320 --> 00:24:21,560
Speaker 3: to their body. And so there are some people who

421
00:24:21,600 --> 00:24:25,119
Speaker 3: have really severe symptoms that persist for many years. There

422
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Speaker 3: are some people who have mild symptoms that get a

423
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Speaker 3: little bit worse, like at the peak of menopause when

424
00:24:29,880 --> 00:24:32,800
Speaker 3: they're really reaching that twelve month mark, and then things

425
00:24:32,800 --> 00:24:36,399
Speaker 3: get better. So that's why that kind of symptom diary

426
00:24:36,520 --> 00:24:38,800
Speaker 3: is so important, so that we can keep track of

427
00:24:39,119 --> 00:24:42,760
Speaker 3: exactly what a patient is experiencing and we can know

428
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Speaker 3: how to tytrate things like sometimes we can start to

429
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Speaker 3: decrease medications. If we put a patient on medications to

430
00:24:49,720 --> 00:24:53,080
Speaker 3: manage symptoms, and now those symptoms are getting better, we

431
00:24:53,119 --> 00:24:56,240
Speaker 3: can try to lean off of those. But for some patients,

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Speaker 3: those symptoms do persist much longer than one would.

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Speaker 1: So you mentioned the vaginal dryn is that it's sometimes

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Speaker 1: a symptom, and I would imagine that impacts a client

435
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Speaker 1: sex life. Are there other kind of sexual things or

436
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Speaker 1: sexual side effects or symptoms that women might experience, either

437
00:25:13,880 --> 00:25:16,640
Speaker 1: during mental pause or in the post mental pausal process

438
00:25:16,760 --> 00:25:18,680
Speaker 1: that you think people should know more about.

439
00:25:19,240 --> 00:25:24,000
Speaker 3: Yeah, I think just in general, decrease libido or decrease

440
00:25:24,119 --> 00:25:28,200
Speaker 3: desire to even engage in sexual activity. And a question

441
00:25:28,280 --> 00:25:30,359
Speaker 3: that I asked my patients when they tell me like, oh,

442
00:25:30,400 --> 00:25:33,320
Speaker 3: I'm not sexually active, I'm not doing that anymore, is

443
00:25:34,000 --> 00:25:36,560
Speaker 3: do you not have the desire to have sex? Or

444
00:25:36,640 --> 00:25:39,600
Speaker 3: is it painful and uncomfortable so then you don't want

445
00:25:39,640 --> 00:25:42,800
Speaker 3: to do it. We can manage those things very differently.

446
00:25:43,080 --> 00:25:46,080
Speaker 3: If it's painful and uncomfortable, maybe we just need to

447
00:25:46,160 --> 00:25:49,360
Speaker 3: treat the vaginal symptoms. If you don't have the desire

448
00:25:49,400 --> 00:25:54,280
Speaker 3: to have sex, is this a component of more mood symptoms,

449
00:25:54,320 --> 00:25:57,240
Speaker 3: depressive symptoms? What's the driver behind this and how can

450
00:25:57,280 --> 00:26:01,720
Speaker 3: we prove your experience there? And so that lack of

451
00:26:01,880 --> 00:26:05,920
Speaker 3: estrogen in the body can really cause changes to the

452
00:26:05,960 --> 00:26:10,480
Speaker 3: integrity of the vaginal tissue. Because of lack of estrogen,

453
00:26:10,520 --> 00:26:14,680
Speaker 3: there's actually decreased blood flow to the vaginal involver tissues,

454
00:26:14,720 --> 00:26:18,960
Speaker 3: which results in decreased lubrication, which can then make things

455
00:26:19,040 --> 00:26:23,280
Speaker 3: very uncomfortable. If a woman is experiencing all these changes

456
00:26:23,320 --> 00:26:28,119
Speaker 3: in her body, how is that affecting her ability to

457
00:26:29,240 --> 00:26:32,280
Speaker 3: relate to herself? How is that affecting her identity? How

458
00:26:32,320 --> 00:26:36,480
Speaker 3: is that affecting how she wants to engage intimately with partners?

459
00:26:36,840 --> 00:26:40,040
Speaker 3: This conversation is just so important to me because we

460
00:26:40,160 --> 00:26:42,480
Speaker 3: need to start talking about these things, right. Like, I

461
00:26:42,520 --> 00:26:45,480
Speaker 3: think there's such a huge role for women to be

462
00:26:45,760 --> 00:26:50,840
Speaker 3: in community and to share their experiences to normalize all

463
00:26:50,840 --> 00:26:53,080
Speaker 3: of this because, like I said, everybody's going to go

464
00:26:53,119 --> 00:26:56,720
Speaker 3: through it at some point, but knowing that other women

465
00:26:56,840 --> 00:26:59,399
Speaker 3: have dealt with this before and kind of having that

466
00:26:59,440 --> 00:27:03,040
Speaker 3: community and people to talk to about how you manage this? Oh,

467
00:27:03,080 --> 00:27:05,280
Speaker 3: what did you try? What things work for you? I

468
00:27:05,280 --> 00:27:07,000
Speaker 3: think that's all really important.

469
00:27:07,200 --> 00:27:09,040
Speaker 1: You brought up a really good point, doctor Freeman, in

470
00:27:09,119 --> 00:27:11,960
Speaker 1: talking about is it that you are no longer interested

471
00:27:12,040 --> 00:27:14,159
Speaker 1: in sex or is it that it is painful or

472
00:27:14,400 --> 00:27:17,000
Speaker 1: you have a different relationship to your body now and

473
00:27:17,040 --> 00:27:19,680
Speaker 1: so you don't think you want sex as much? Is

474
00:27:19,720 --> 00:27:21,280
Speaker 1: there a point? And I feel like this is something

475
00:27:21,280 --> 00:27:23,600
Speaker 1: that we hear often, and I don't know if this

476
00:27:23,680 --> 00:27:25,360
Speaker 1: is actually true, so I'd love for you to kind

477
00:27:25,359 --> 00:27:27,760
Speaker 1: of debunk this myth. Is there a point at our

478
00:27:27,800 --> 00:27:30,080
Speaker 1: lives in which we can expect to no longer have

479
00:27:30,160 --> 00:27:32,399
Speaker 1: a libido? Is it at some point that is like

480
00:27:32,440 --> 00:27:34,760
Speaker 1: a certain age range where you're thinking like, oh, yeah,

481
00:27:34,920 --> 00:27:37,200
Speaker 1: like that it's typical for people of this age.

482
00:27:37,440 --> 00:27:39,719
Speaker 2: Yeah, that's a really good question.

483
00:27:39,880 --> 00:27:42,040
Speaker 3: I'm not sure I have an exact answer to it,

484
00:27:42,160 --> 00:27:44,960
Speaker 3: but what I will say is that we see a

485
00:27:45,000 --> 00:27:47,280
Speaker 3: wide range of patients. That's one thing that I love

486
00:27:47,440 --> 00:27:51,480
Speaker 3: about obgi N is we see patients from preteen years

487
00:27:51,560 --> 00:27:54,639
Speaker 3: all the way through benepause and later stages of life,

488
00:27:55,280 --> 00:27:58,240
Speaker 3: and I feel like we see a wide variety. There

489
00:27:58,280 --> 00:28:01,840
Speaker 3: are some patients who might be earlier in the menopausal

490
00:28:01,880 --> 00:28:04,440
Speaker 3: transition and are like, Nope, I'm not interested in that.

491
00:28:04,800 --> 00:28:07,200
Speaker 3: My libido has just really decreased.

492
00:28:07,520 --> 00:28:08,000
Speaker 2: And there are some.

493
00:28:08,040 --> 00:28:11,239
Speaker 3: Patients who are, you know, well into their transition and

494
00:28:11,480 --> 00:28:14,240
Speaker 3: they still got it, They're still going. And so I'm

495
00:28:14,240 --> 00:28:18,679
Speaker 3: not really sure exactly what the differences are and how

496
00:28:19,040 --> 00:28:22,520
Speaker 3: some patients might continue to maintain that libido while other

497
00:28:22,560 --> 00:28:25,159
Speaker 3: patients don't. But I will say that there is a

498
00:28:25,320 --> 00:28:28,000
Speaker 3: wide range of people's experience with that.

499
00:28:28,440 --> 00:28:30,480
Speaker 1: So, doctor Freeman, you know, the other thing I think

500
00:28:30,600 --> 00:28:32,800
Speaker 1: that's important to talk about is that it feels like

501
00:28:32,880 --> 00:28:36,600
Speaker 1: there is also a group of people who will enter

502
00:28:36,680 --> 00:28:40,640
Speaker 1: menopause maybe earlier then you might expect. Can you speak

503
00:28:40,680 --> 00:28:42,960
Speaker 1: to that, because what age would you expect to kind

504
00:28:42,960 --> 00:28:45,960
Speaker 1: of maybe see people having some pre menopausal symptoms and

505
00:28:46,040 --> 00:28:48,600
Speaker 1: at what point would you say, oh, they are experiencing

506
00:28:48,640 --> 00:28:49,520
Speaker 1: early menopause.

507
00:28:49,600 --> 00:28:53,640
Speaker 3: Yeah, So the average age of menopause is about fifty one,

508
00:28:54,440 --> 00:28:58,560
Speaker 3: and the perimenopausal period, so those changes in your periods,

509
00:28:59,000 --> 00:29:02,920
Speaker 3: start of hot flag or sleep changes, those things can

510
00:29:03,000 --> 00:29:07,200
Speaker 3: happen as early as four years before the final mental period.

511
00:29:07,240 --> 00:29:10,480
Speaker 3: So let's say your fino mental period is age fifty one,

512
00:29:10,920 --> 00:29:14,800
Speaker 3: you may start having these symptoms as early as forty seven, right,

513
00:29:15,320 --> 00:29:18,640
Speaker 3: And then the ways that we define early menopause, it's

514
00:29:18,680 --> 00:29:21,760
Speaker 3: really by age. So since we know that the average

515
00:29:21,760 --> 00:29:25,240
Speaker 3: age is fifty one, we define early menopause as going

516
00:29:25,280 --> 00:29:28,840
Speaker 3: through that transition between the ages of forty and forty five.

517
00:29:29,440 --> 00:29:33,160
Speaker 3: And there are even some patients who have the shutdown

518
00:29:33,200 --> 00:29:37,240
Speaker 3: of their ovaries this menopausal transition even less than forty

519
00:29:37,280 --> 00:29:40,120
Speaker 3: and that's you know, a different condition called primary ovarian

520
00:29:40,200 --> 00:29:45,160
Speaker 3: insufficiency where the ovaries just aren't functioning, the eggs are depleted,

521
00:29:45,400 --> 00:29:49,160
Speaker 3: and we see that that's not an uncommon condition. And

522
00:29:49,240 --> 00:29:53,240
Speaker 3: so if you're experiencing these symptoms less than forty or

523
00:29:53,240 --> 00:29:57,600
Speaker 3: early forties, again, bring this up with your healthcare provider,

524
00:29:58,160 --> 00:30:02,200
Speaker 3: because that may be outside the realm of normal. And

525
00:30:02,520 --> 00:30:07,360
Speaker 3: depending on when a patient is experiencing these symptoms, that

526
00:30:07,480 --> 00:30:11,240
Speaker 3: may change what types of treatments they can be offered.

527
00:30:11,320 --> 00:30:16,000
Speaker 3: So again, we try not to offer hormonal therapies ten

528
00:30:16,080 --> 00:30:20,880
Speaker 3: plus years after the final mental period because that could

529
00:30:20,960 --> 00:30:25,320
Speaker 3: increase the person's risk for stroke and cardiovascular disease and

530
00:30:25,360 --> 00:30:27,480
Speaker 3: all these things that we worry about. And so I

531
00:30:27,480 --> 00:30:31,600
Speaker 3: think one the sooner people talk about these symptoms, the

532
00:30:31,680 --> 00:30:34,720
Speaker 3: sooner they can have a diagnosis and know whether this

533
00:30:34,920 --> 00:30:39,440
Speaker 3: is within what's expected or not. But something that that

534
00:30:39,480 --> 00:30:44,480
Speaker 3: I've come across recently is just information about black women's

535
00:30:44,520 --> 00:30:47,640
Speaker 3: experiences with menopause. I was scrolling on Instagram and I

536
00:30:47,680 --> 00:30:51,720
Speaker 3: saw a post that said black women experience menopause earlier,

537
00:30:51,840 --> 00:30:54,880
Speaker 3: they have worse symptoms, and they're less likely to seek

538
00:30:54,920 --> 00:30:58,320
Speaker 3: treatment for those symptoms. I was like, well, I mean,

539
00:30:58,840 --> 00:31:02,120
Speaker 3: I can understand this, right, Like, anecdotally, we know that

540
00:31:02,520 --> 00:31:06,280
Speaker 3: black people, especially in the United States have worse health

541
00:31:06,320 --> 00:31:10,160
Speaker 3: outcomes in so many different realms. And this is not

542
00:31:10,280 --> 00:31:13,680
Speaker 3: because of our race itself, but it's because of racism

543
00:31:14,040 --> 00:31:17,160
Speaker 3: and discrimination that has occurred in the healthcare industry as

544
00:31:17,200 --> 00:31:19,600
Speaker 3: a whole. And that's a whole different topic that we

545
00:31:19,600 --> 00:31:22,960
Speaker 3: can spend an hour talking about. But I was really

546
00:31:23,040 --> 00:31:27,520
Speaker 3: curious whether this claim of black women experiencing worse menopause

547
00:31:27,520 --> 00:31:30,400
Speaker 3: symptoms is backed by evidence, and it turns out that

548
00:31:30,440 --> 00:31:30,800
Speaker 3: it is.

549
00:31:30,920 --> 00:31:31,040
Speaker 2: So.

550
00:31:31,080 --> 00:31:33,440
Speaker 3: There was a research study called the SWAN Study, which

551
00:31:33,480 --> 00:31:36,480
Speaker 3: stands for the Study of Women's Health across the Nation,

552
00:31:37,000 --> 00:31:39,320
Speaker 3: and it followed thousands of women in the US of

553
00:31:39,400 --> 00:31:43,600
Speaker 3: various ethnicities over several years, over fifteen years to kind

554
00:31:43,640 --> 00:31:46,520
Speaker 3: of learn more about the menopausal transition and symptoms that

555
00:31:46,560 --> 00:31:49,760
Speaker 3: people experience. And the black women in this study actually

556
00:31:49,800 --> 00:31:54,400
Speaker 3: experienced menopause eight and a half months earlier than white women.

557
00:31:54,640 --> 00:31:58,480
Speaker 3: Black women were more likely to experience those vasomotor symptoms

558
00:31:58,480 --> 00:32:02,560
Speaker 3: so hot flashes and nights, and to experience those for

559
00:32:02,600 --> 00:32:05,760
Speaker 3: a longer period of time. Black women were less likely

560
00:32:05,840 --> 00:32:09,360
Speaker 3: to use hormone replacement therapy, and they were more likely

561
00:32:09,400 --> 00:32:12,760
Speaker 3: to experience depressive symptoms. And so, you know, I think

562
00:32:12,880 --> 00:32:17,120
Speaker 3: when we're talking about the menopausal transition, it's so important

563
00:32:17,160 --> 00:32:22,960
Speaker 3: to center our community, right because we are having an

564
00:32:23,120 --> 00:32:26,920
Speaker 3: entirely different experience when it comes to menopause. And so

565
00:32:26,960 --> 00:32:30,840
Speaker 3: I'm so so grateful that we're having this conversation so

566
00:32:30,880 --> 00:32:34,280
Speaker 3: that women can know what to expect, what's normal, what's

567
00:32:34,320 --> 00:32:34,920
Speaker 3: not normal?

568
00:32:35,280 --> 00:32:36,120
Speaker 2: Is this too soon?

569
00:32:36,920 --> 00:32:39,560
Speaker 3: Or am I still having bleeding and I'm in my

570
00:32:39,680 --> 00:32:43,440
Speaker 3: late fifties right, that's also abnormal, So that should be

571
00:32:43,520 --> 00:32:45,160
Speaker 3: checked out more.

572
00:32:44,960 --> 00:32:58,280
Speaker 1: From our conversation after the break Tucher Freeman, do you

573
00:32:58,360 --> 00:33:00,560
Speaker 1: think that there is some connection or have you seen

574
00:33:00,600 --> 00:33:04,080
Speaker 1: any research that talks about a connection related to the

575
00:33:04,080 --> 00:33:08,680
Speaker 1: weathering impact and that being connected to maybe menopause starting earlier.

576
00:33:08,760 --> 00:33:10,960
Speaker 1: What do you make of the idea that black women

577
00:33:11,440 --> 00:33:14,400
Speaker 1: will sometimes start menopause, at least in this study earlier

578
00:33:14,480 --> 00:33:15,800
Speaker 1: than the rest of their participants.

579
00:33:16,200 --> 00:33:19,480
Speaker 3: Yeah, so in the Swan study, they didn't actually look

580
00:33:19,520 --> 00:33:24,400
Speaker 3: at racism, discrimination, all those things as factors. But I

581
00:33:24,400 --> 00:33:27,000
Speaker 3: think we can make assumptions we can extrapolate based on

582
00:33:27,040 --> 00:33:30,440
Speaker 3: this data, and so in various other aspects of health

583
00:33:30,440 --> 00:33:33,160
Speaker 3: and healthcare. We know that weathering does play a role.

584
00:33:33,400 --> 00:33:38,080
Speaker 3: We know that chronic exposure to racism and trauma throughout

585
00:33:38,120 --> 00:33:43,360
Speaker 3: generations plays a role in how different conditions manifest in

586
00:33:43,440 --> 00:33:46,960
Speaker 3: Black people, and so I think this is absolutely part

587
00:33:47,040 --> 00:33:52,440
Speaker 3: of that same phenomenon. Black women experience racism constantly. There's

588
00:33:52,520 --> 00:33:56,800
Speaker 3: lots of pressures on Black women, and especially the incidents

589
00:33:56,800 --> 00:34:00,320
Speaker 3: of depressive symptoms being higher. I wonder how much of

590
00:34:00,360 --> 00:34:04,120
Speaker 3: that relates to that chronic weathering and the pressures that

591
00:34:04,160 --> 00:34:07,400
Speaker 3: society puts on women in general, but especially on Black women.

592
00:34:07,800 --> 00:34:11,000
Speaker 3: That's something that we can't ignore, right, Like, these differences

593
00:34:11,080 --> 00:34:16,760
Speaker 3: exist for a reason, and I think unfortunately in medicine

594
00:34:16,800 --> 00:34:21,600
Speaker 3: and in research, there isn't always the attention paid to

595
00:34:22,040 --> 00:34:27,239
Speaker 3: the differences that black populations experience, and so often it's

596
00:34:27,400 --> 00:34:30,320
Speaker 3: labeled as, oh, well, black people have worse health outcomes,

597
00:34:30,360 --> 00:34:32,960
Speaker 3: Black people have this, they have that, But why, right?

598
00:34:33,360 --> 00:34:36,319
Speaker 3: And I think that's exactly what you're speaking to. And

599
00:34:36,400 --> 00:34:41,279
Speaker 3: I'm hopeful that as we try to increase representation of

600
00:34:41,400 --> 00:34:44,400
Speaker 3: black people in the field of medicine, that more of

601
00:34:44,480 --> 00:34:47,640
Speaker 3: us will spend dedicated research time on these topics and

602
00:34:47,719 --> 00:34:52,040
Speaker 3: trying to elucidate exactly what the influences are, exactly what

603
00:34:52,400 --> 00:34:55,480
Speaker 3: those factors are that are contributing to the health care

604
00:34:55,480 --> 00:34:57,520
Speaker 3: disparities that we do see in our community.

605
00:34:57,880 --> 00:35:00,839
Speaker 1: Thank you for that. So you mentioned that bleeding after

606
00:35:00,920 --> 00:35:04,279
Speaker 1: fifty is also a concern, which I think some people

607
00:35:04,360 --> 00:35:06,560
Speaker 1: might miss, right, because you've already talked about like how

608
00:35:06,600 --> 00:35:09,399
Speaker 1: this affirms people's identity. So this idea that you're still

609
00:35:09,400 --> 00:35:11,960
Speaker 1: bleeding kind of feels like, oh, I haven't experienced that yet,

610
00:35:12,000 --> 00:35:14,520
Speaker 1: like I'm lucky kind of thing. Right. Can you talk

611
00:35:14,680 --> 00:35:17,680
Speaker 1: more about like why bleeding after fifty might also still

612
00:35:17,719 --> 00:35:18,360
Speaker 1: be a concern.

613
00:35:18,520 --> 00:35:22,120
Speaker 3: Yeah, average age of menopause is fifty one, so that

614
00:35:22,200 --> 00:35:25,759
Speaker 3: means some people experience it sooner, some people experience it later.

615
00:35:26,320 --> 00:35:29,120
Speaker 2: But I think if you're well into.

616
00:35:28,880 --> 00:35:34,920
Speaker 3: Your fifties fifty five plus and you're still having regular bleeding, again,

617
00:35:34,960 --> 00:35:37,480
Speaker 3: this is something to have a conversation about with your

618
00:35:37,640 --> 00:35:43,000
Speaker 3: healthcare provider, especially if you have certain risk factors for

619
00:35:43,080 --> 00:35:45,800
Speaker 3: something we talked about, which is uterine cancer. And I

620
00:35:45,880 --> 00:35:47,880
Speaker 3: don't want to be morbid, but I feel like people

621
00:35:48,320 --> 00:35:50,520
Speaker 3: need to know what to expect and need to know

622
00:35:50,560 --> 00:35:53,560
Speaker 3: what these warning signs and risk factors are. And so

623
00:35:53,840 --> 00:35:58,279
Speaker 3: for some women who deal with obesity, for example, the

624
00:35:58,440 --> 00:36:02,680
Speaker 3: adipose tissue or the fat in the body actually produce

625
00:36:02,880 --> 00:36:07,040
Speaker 3: their own estrogen. And so when the circulating estrogen levels

626
00:36:07,040 --> 00:36:10,160
Speaker 3: in the body are higher, that can actually cause the

627
00:36:10,200 --> 00:36:13,600
Speaker 3: tissue in the lining of the uterus or the endometrium

628
00:36:13,760 --> 00:36:18,200
Speaker 3: to proliferate or grow more. And so as a person

629
00:36:18,640 --> 00:36:22,160
Speaker 3: is having this thicken endometrium, they may have more bleeding,

630
00:36:22,239 --> 00:36:24,920
Speaker 3: they may have continue bleeding for longer periods of time

631
00:36:25,440 --> 00:36:29,360
Speaker 3: because there's abnormal growth happening there. And so obesity is

632
00:36:29,400 --> 00:36:33,320
Speaker 3: one of the risk factors. Earlier age when you started

633
00:36:33,360 --> 00:36:37,839
Speaker 3: your periods, or transitioning into menopause later like, these are

634
00:36:37,840 --> 00:36:42,040
Speaker 3: all risk factors for uterine cancer. Never having children is

635
00:36:42,080 --> 00:36:45,200
Speaker 3: also a risk factor. There are some medications that are

636
00:36:45,560 --> 00:36:49,360
Speaker 3: used to treat different cancers, to treat riast cancer, for example,

637
00:36:49,680 --> 00:36:54,239
Speaker 3: that can contribute to uterine cancer their genetic syndromes where

638
00:36:54,320 --> 00:36:57,160
Speaker 3: uterine cancer is more common. And so I think if

639
00:36:57,200 --> 00:36:59,799
Speaker 3: you find yourself to be falling outside of that room

640
00:36:59,800 --> 00:37:03,879
Speaker 3: of right you're fifty five plus, I'm using fifty five

641
00:37:03,920 --> 00:37:06,160
Speaker 3: as kind of an arbitrary age because it seems like

642
00:37:06,200 --> 00:37:09,480
Speaker 3: that would be really beyond that average of fifty one

643
00:37:09,960 --> 00:37:14,000
Speaker 3: and you're still having bleeding, Please just go get evaluated.

644
00:37:14,040 --> 00:37:16,920
Speaker 3: I'm not saying that you do have cancer, but I

645
00:37:16,920 --> 00:37:18,960
Speaker 3: think that's something that we really just want to be

646
00:37:19,360 --> 00:37:23,400
Speaker 3: vigilant about because we know that, again, our outcomes with

647
00:37:23,640 --> 00:37:28,320
Speaker 3: uterine cancer specifically are very poor and very very sad.

648
00:37:28,480 --> 00:37:31,960
Speaker 1: Honestly, so I would imagine nature Freeman, that several people's

649
00:37:32,000 --> 00:37:34,440
Speaker 1: eyebrows went up, just like min did when you mentioned

650
00:37:34,440 --> 00:37:37,839
Speaker 1: never having children as a risk factor. Can you say

651
00:37:37,840 --> 00:37:38,880
Speaker 1: more about why that is.

652
00:37:39,280 --> 00:37:44,480
Speaker 3: When patients are getting pregnant and having children, we know

653
00:37:44,560 --> 00:37:48,799
Speaker 3: that that kind of changes the functioning of the uterus

654
00:37:48,840 --> 00:37:52,600
Speaker 3: and the uterine lining, and so for patients who have

655
00:37:53,239 --> 00:37:58,840
Speaker 3: never experienced childbirth, their uterus is just function completely differently.

656
00:37:58,880 --> 00:38:02,240
Speaker 3: They've never had that kind of period of not having

657
00:38:02,280 --> 00:38:06,040
Speaker 3: that proliferation. What we think about is what's called prolonged

658
00:38:06,120 --> 00:38:10,120
Speaker 3: unopposed estrogen exposure, which means you're having estrogen but not

659
00:38:10,200 --> 00:38:13,439
Speaker 3: having that progesterone to come back and quiet things down.

660
00:38:13,880 --> 00:38:17,759
Speaker 3: Progesterone is really high when someone is pregnant, and so

661
00:38:18,400 --> 00:38:22,520
Speaker 3: not having children just changes the way that your hormones

662
00:38:22,680 --> 00:38:25,600
Speaker 3: have been affecting your uterus throughout your lifetime.

663
00:38:25,440 --> 00:38:27,560
Speaker 1: You know, doctor free and I have seen recently it

664
00:38:27,560 --> 00:38:30,399
Speaker 1: feels like people trying to use technology to maybe deal

665
00:38:30,440 --> 00:38:33,040
Speaker 1: with some of the symptoms. So I'm sure you've seen

666
00:38:33,080 --> 00:38:36,560
Speaker 1: like different wearables for people who have like hot flashes,

667
00:38:36,640 --> 00:38:38,320
Speaker 1: and I don't know if they give you the sensation

668
00:38:38,440 --> 00:38:41,560
Speaker 1: of like cooling or something. Is there any technology or

669
00:38:41,600 --> 00:38:43,920
Speaker 1: things that are coming down the pipeline that you are

670
00:38:43,960 --> 00:38:46,719
Speaker 1: excited about or that you have seen be effective for

671
00:38:46,800 --> 00:38:47,760
Speaker 1: any of your patients.

672
00:38:48,120 --> 00:38:52,160
Speaker 3: Yeah, something that is coming down the pipeline is a

673
00:38:52,239 --> 00:38:58,279
Speaker 3: new medication that's actually non hormonal to treat menopausal symptoms.

674
00:38:58,520 --> 00:39:02,520
Speaker 3: It's going through try and going through FDA approval now.

675
00:39:02,880 --> 00:39:04,879
Speaker 3: But I think this could be a really big deal

676
00:39:05,040 --> 00:39:09,400
Speaker 3: for patients who are high risk for hormonal therapy, where

677
00:39:09,480 --> 00:39:12,120
Speaker 3: you know, they have history of heart disease or history

678
00:39:12,120 --> 00:39:15,319
Speaker 3: of stroke or some other condition where hormonal therapy isn't

679
00:39:15,360 --> 00:39:18,360
Speaker 3: right for them, and maybe those other treatments weren't working,

680
00:39:18,400 --> 00:39:21,760
Speaker 3: the SSRIs aren't working, the anti sesual medications aren't working.

681
00:39:22,200 --> 00:39:24,520
Speaker 3: There may be a new option, And I think that's

682
00:39:24,760 --> 00:39:28,560
Speaker 3: huge because again, there is so much stigma around hormone

683
00:39:28,600 --> 00:39:33,600
Speaker 3: replacement concern for it precipitating cancer or causing you to

684
00:39:33,680 --> 00:39:36,319
Speaker 3: have higher risk for cancer. And so a lot of

685
00:39:36,320 --> 00:39:39,680
Speaker 3: women that I've seen are opposed to hormonal therapy, and

686
00:39:39,680 --> 00:39:41,120
Speaker 3: so this just gives another option.

687
00:39:41,560 --> 00:39:43,680
Speaker 1: We'll be on the lookout for information related to that.

688
00:39:44,400 --> 00:39:46,720
Speaker 1: So You've already mentioned a few things, but I'm wondering

689
00:39:46,760 --> 00:39:48,600
Speaker 1: is there anything else that you feel like is missing

690
00:39:48,680 --> 00:39:51,600
Speaker 1: from the conversation as it released to Black women in menopause.

691
00:39:51,920 --> 00:39:56,480
Speaker 3: I think the biggest one for me was the difference

692
00:39:56,560 --> 00:40:01,320
Speaker 3: in the experience of Black women and menopause and that

693
00:40:02,360 --> 00:40:06,480
Speaker 3: not a lot of providers are educated about this. You know,

694
00:40:06,520 --> 00:40:09,680
Speaker 3: I'm an OBGYN resident, and even in a lot of

695
00:40:09,680 --> 00:40:15,120
Speaker 3: OBGYN residency programs, there's not formal education about menopause. I

696
00:40:15,160 --> 00:40:18,200
Speaker 3: happen to be training at a place where people value

697
00:40:18,239 --> 00:40:21,359
Speaker 3: this information and think it's important and want to make

698
00:40:21,400 --> 00:40:24,439
Speaker 3: sure that we are as well versed as we can

699
00:40:24,520 --> 00:40:26,919
Speaker 3: be and can take care of our patients as best

700
00:40:26,960 --> 00:40:30,480
Speaker 3: as possible with whatever life experiences they're having. And so

701
00:40:30,760 --> 00:40:35,040
Speaker 3: I think it's super important for one providers to educate

702
00:40:35,080 --> 00:40:39,880
Speaker 3: themselves for patients to also educate themselves. I encourage patients

703
00:40:39,960 --> 00:40:41,759
Speaker 3: to do their own research. I know there are some

704
00:40:41,840 --> 00:40:46,239
Speaker 3: doctors who are like, don't google anything. Google will tell

705
00:40:46,280 --> 00:40:48,880
Speaker 3: you all the craziest things. But I want to know

706
00:40:48,920 --> 00:40:50,640
Speaker 3: what you found on Google. I want to know what

707
00:40:50,680 --> 00:40:54,200
Speaker 3: your auntie told you so that we can talk about it, right, Like,

708
00:40:54,440 --> 00:40:57,600
Speaker 3: is this true? Is some of this myth? Is some

709
00:40:57,680 --> 00:41:01,200
Speaker 3: of this old wives tales? Or how much of this is?

710
00:41:01,239 --> 00:41:01,400
Speaker 2: You know?

711
00:41:01,520 --> 00:41:05,319
Speaker 3: Actually fact that we need to pay attention to. Again,

712
00:41:05,400 --> 00:41:07,960
Speaker 3: this is just such an important conversation, and I'm so

713
00:41:08,120 --> 00:41:10,880
Speaker 3: grateful to you for having me here to talk about

714
00:41:10,920 --> 00:41:14,399
Speaker 3: these things, because it's not common that we have these

715
00:41:14,440 --> 00:41:16,239
Speaker 3: conversations in our community. You know.

716
00:41:16,320 --> 00:41:17,080
Speaker 2: I even think.

717
00:41:16,920 --> 00:41:19,799
Speaker 3: About my mom and my aunts. I remember when I

718
00:41:19,880 --> 00:41:25,520
Speaker 3: started Obgin residency. My mom was constantly talking about her

719
00:41:25,560 --> 00:41:28,000
Speaker 3: hot flashes. Oh my god, this is crazy, Like I

720
00:41:28,080 --> 00:41:30,359
Speaker 3: just got to deal with this, like what can I do?

721
00:41:30,920 --> 00:41:33,560
Speaker 3: And at that point I was empowered with this information

722
00:41:33,600 --> 00:41:35,680
Speaker 3: and I actually shared a lot with her. Right, Oh,

723
00:41:35,680 --> 00:41:38,080
Speaker 3: go ask your doctor about this. Have you thought about this?

724
00:41:38,200 --> 00:41:40,799
Speaker 3: Are you having mood symptoms? Maybe these things could work

725
00:41:40,840 --> 00:41:44,200
Speaker 3: for you. And so I'm very grateful for the education

726
00:41:44,320 --> 00:41:47,440
Speaker 3: that I've received to be able to share this information.

727
00:41:47,600 --> 00:41:48,640
Speaker 2: Right, I don't know everything.

728
00:41:48,680 --> 00:41:51,880
Speaker 3: I'm not an expert, but I think it's a great

729
00:41:51,920 --> 00:41:55,120
Speaker 3: starting point to be able to have these conversations within

730
00:41:55,160 --> 00:41:56,560
Speaker 3: our community. Mm hm.

731
00:41:57,320 --> 00:41:59,600
Speaker 1: So there's a conversation online that I want to ask

732
00:41:59,640 --> 00:42:01,759
Speaker 1: you to weigh in if you've heard anything about this.

733
00:42:02,239 --> 00:42:05,560
Speaker 1: So there's a thought that black women have always existed

734
00:42:05,600 --> 00:42:08,319
Speaker 1: because you were an egg in your mother's womb. Who

735
00:42:08,400 --> 00:42:11,040
Speaker 1: was an egg in her mother's womb? Is this real

736
00:42:11,120 --> 00:42:13,720
Speaker 1: science or is this kind of like a black girl magic,

737
00:42:13,800 --> 00:42:15,920
Speaker 1: afrofuturist kind of sentiment.

738
00:42:16,600 --> 00:42:21,000
Speaker 3: Yeah, so this actually is real science. So when a

739
00:42:21,120 --> 00:42:25,800
Speaker 3: female fetus is forming, her reproductive organs are also forming,

740
00:42:25,880 --> 00:42:29,319
Speaker 3: so her ovaries are forming, and when she's born, she

741
00:42:29,640 --> 00:42:33,120
Speaker 3: has all of the eggs that she will ever need

742
00:42:33,320 --> 00:42:36,839
Speaker 3: in her lifetime already in those ovaries. And so if

743
00:42:36,880 --> 00:42:41,239
Speaker 3: you think about it, if your mom was in your grandmother,

744
00:42:42,040 --> 00:42:46,000
Speaker 3: your mom's ovaries already had the eggs that would eventually

745
00:42:46,360 --> 00:42:50,000
Speaker 3: get fertilized and become you. So yeah, that actually is

746
00:42:50,080 --> 00:42:51,880
Speaker 3: real science. Love it.

747
00:42:52,120 --> 00:42:55,040
Speaker 1: Thank you for sharing that. So you've already talked about

748
00:42:55,080 --> 00:42:57,440
Speaker 1: the importance of having more of these conversations, But what

749
00:42:57,520 --> 00:43:00,880
Speaker 1: kind of future do you want to build regarding menopause awareness?

750
00:43:01,239 --> 00:43:04,880
Speaker 3: My ultimate goal is to be a high risk of

751
00:43:05,040 --> 00:43:11,200
Speaker 3: stetrics specialists, So menopause is one of the components of

752
00:43:11,239 --> 00:43:15,760
Speaker 3: my training, and I hope that in the future women

753
00:43:15,920 --> 00:43:21,799
Speaker 3: can be more comfortable having these conversations, whether online, in churches,

754
00:43:22,239 --> 00:43:25,359
Speaker 3: in the hair salon, whatever the case may be. I

755
00:43:25,480 --> 00:43:29,920
Speaker 3: just envision a future where women are more educated about

756
00:43:30,040 --> 00:43:32,640
Speaker 3: the changes that will happen in their bodies. They are

757
00:43:32,719 --> 00:43:37,360
Speaker 3: empowered to speak up, to advocate for themselves, to say,

758
00:43:37,480 --> 00:43:40,160
Speaker 3: this doesn't seem right, this doesn't seem normal. Is there

759
00:43:40,160 --> 00:43:43,360
Speaker 3: something that can be done for this? Is there something

760
00:43:43,360 --> 00:43:46,799
Speaker 3: that I could be thinking about differently to manage these symptoms?

761
00:43:47,280 --> 00:43:50,840
Speaker 3: And so my ultimate goal for any patient that I

762
00:43:50,880 --> 00:43:55,080
Speaker 3: come across, and all patients in general, is empowerment and

763
00:43:55,160 --> 00:43:58,600
Speaker 3: just knowing that you have choices, you have options, you

764
00:43:58,680 --> 00:44:01,960
Speaker 3: have a voice. And I'm hopeful that through all of

765
00:44:01,960 --> 00:44:05,919
Speaker 3: our efforts to diversify the physician workforce, that we will

766
00:44:05,960 --> 00:44:09,560
Speaker 3: have more physicians who listen to us, who take our

767
00:44:09,600 --> 00:44:13,680
Speaker 3: symptoms seriously, who aren't dismissing us, and who can actually

768
00:44:13,719 --> 00:44:18,040
Speaker 3: help us make sustainable changes to improve our quality of life.

769
00:44:18,239 --> 00:44:20,879
Speaker 1: Thank you for that, doctor Freeman. So where can we

770
00:44:21,000 --> 00:44:23,879
Speaker 1: stay updated with all the incredible things that you're doing.

771
00:44:23,880 --> 00:44:26,080
Speaker 1: Do you have a website in any social media handles

772
00:44:26,120 --> 00:44:26,880
Speaker 1: you'd like to share.

773
00:44:27,320 --> 00:44:29,600
Speaker 2: I am on social media.

774
00:44:29,960 --> 00:44:35,440
Speaker 3: My Instagram is Christy free Underscore MD. I'm also on Twitter.

775
00:44:35,680 --> 00:44:39,480
Speaker 3: I like to share a lot about my journey through

776
00:44:39,520 --> 00:44:44,000
Speaker 3: residency on my social media. For me, I am the

777
00:44:44,040 --> 00:44:48,640
Speaker 3: first physician in my family, and so I'm figuring this

778
00:44:48,719 --> 00:44:52,000
Speaker 3: whole process out as I go, and so I've been

779
00:44:52,239 --> 00:44:55,920
Speaker 3: documenting my journey for other people to see, other people

780
00:44:55,920 --> 00:44:58,680
Speaker 3: who don't have that example, so they can know what

781
00:44:58,760 --> 00:45:02,560
Speaker 3: this experience is like. Since he is hard. It's one

782
00:45:02,600 --> 00:45:05,760
Speaker 3: of the hardest things I've ever done. And my social

783
00:45:05,800 --> 00:45:08,200
Speaker 3: media is where I find that community. There's so many

784
00:45:08,680 --> 00:45:13,200
Speaker 3: residents Black OBGYN residents that I'm in community with online

785
00:45:13,320 --> 00:45:16,600
Speaker 3: and via Instagram, and that's how we remain connected and

786
00:45:16,640 --> 00:45:19,840
Speaker 3: support each other. So anyone who's interested in medicine or

787
00:45:19,880 --> 00:45:23,919
Speaker 3: just interested in what's a residen's life like, definitely check

788
00:45:23,960 --> 00:45:24,239
Speaker 3: me out.

789
00:45:24,440 --> 00:45:26,840
Speaker 1: Absolutely, we'll be sure to include all of that in

790
00:45:26,880 --> 00:45:29,040
Speaker 1: the show notes. Well, thank you so much for me

791
00:45:29,120 --> 00:45:31,879
Speaker 1: some time with us today, doctor Freeman. I really appreciate it.

792
00:45:32,200 --> 00:45:33,920
Speaker 2: Thank you so much for having me.

793
00:45:37,040 --> 00:45:39,279
Speaker 1: I'm so glad doctor Freeman was able to share her

794
00:45:39,280 --> 00:45:42,319
Speaker 1: expertise with us today. To learn more about her and

795
00:45:42,360 --> 00:45:45,440
Speaker 1: her work, visit the show notes at Therapy for Blackgirls

796
00:45:45,440 --> 00:45:49,160
Speaker 1: dot com slash Session three nineteen and don't forget to

797
00:45:49,239 --> 00:45:51,839
Speaker 1: chext two of your girls right now and encourage them

798
00:45:51,880 --> 00:45:54,880
Speaker 1: to check out the episode. If you're looking for a

799
00:45:54,920 --> 00:45:58,279
Speaker 1: therapist in your area, check out our therapist directory at

800
00:45:58,320 --> 00:46:02,160
Speaker 1: Therapy for Blackgirls dot com directory. And if you want

801
00:46:02,160 --> 00:46:04,560
Speaker 1: to continue digging into this topic or just be in

802
00:46:04,600 --> 00:46:07,680
Speaker 1: community with other sisters, come on over and join us

803
00:46:07,680 --> 00:46:10,440
Speaker 1: in the Sister Circle. It's our cozy corner of the

804
00:46:10,440 --> 00:46:13,759
Speaker 1: Internet designed just for black women. You can join us

805
00:46:13,800 --> 00:46:18,440
Speaker 1: at community dot Therapy for Blackgirls dot com. This episode

806
00:46:18,520 --> 00:46:22,120
Speaker 1: was produced by Frida Lucas, Elise Ellis, and Zaria Taylor.

807
00:46:23,040 --> 00:46:26,960
Speaker 1: Editing was done by Dennison Bradford. Thank y'all so much

808
00:46:26,960 --> 00:46:29,719
Speaker 1: for joining me again this week. I look forward to

809
00:46:29,760 --> 00:46:34,120
Speaker 1: continuing this conversation with you all real soon. Take good care.

810
00:46:39,000 --> 00:46:41,560
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811
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812
00:46:45,840 --> 00:46:49,280
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814
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815
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