It's time to be well with your health. I'm Shanna.

And I'm Nimeet.

Welcome to the Adventist HealthCare and You podcast.

We have a great topic today. Nimeet, I'm sorry. This is not your topic, but Well, it's it may help you later in life.

I think it'll be hugely beneficial as our family is growing. Yes. You know, we could help our people around us and in the community.

Yes. Yes. So, today, we are talking about perimenopause, a topic that is near and dear to my heart. I have entered a stage of life where I am thinking about this. We have a wonderful guest today, Dr. Carolyn Young. Welcome, Dr. Young.

Thanks so much for having me.

I know you're you are a longtime supporter of Adventist HealthCare Shady Grove Medical Center.

You are based at the practice Rockville Gynecology. Right?

Correct.

Okay. How long have you been there?

So I actually founded it Yes. Fifteen years ago. And I was a solo practitioner for three years, and it has grown, and we now have seven providers. Okay. Yeah. So it's it's been really awesome.

So tell us a little bit about your practice and yourself and how we can approach this topic today.

Excellent. I went to medical school at Vanderbilt and then went to Eastern Virginia Medical School for residency, Moved here because I married someone who graduated from the Naval Academy and was in the Navy and went to Bethesda. He's a GI doctor.

But luckily, we were able to stay here, and we've been here. I've been on staff at Shady Grove for twenty one years.

And as my life evolved, I really had a passion for preventive care for women, trying to keep women healthy, figuring out what we can do to prevent disease.

And I have a special interest in minimally invasive GYN surgery Mhmm.

And the da Vinci robots. So I started my own practice GYN only focusing on those topics.

Before we get into our topic of perimenopause, Dr. Young, you have a fun fact that recently was announced.

Can you tell us what this fun fact is?

Yes.

In December of twenty twenty three, I did a surgery at Shady Grove and removed two hundred and fifty eight fibroids from one patient. Oh, wow. And, so then we applied to the Guinness Book of World Records and got admitted.

So I hold the highest Fantastic. The highest number. Before me, I think it was two hundred and thirty five fibroids.

So we're now at two hundred fifty eight. The only thing that's a little bit of a bummer is that the patient, her name is in the Guinness Book of World Records and the fact that it happened in Rockville, but they didn't include my name as the surgeon.

So I've I've unfortunate.

In the process of reaching out to them saying, could you please create a new item where, the surgeon that removes those fibroids can be listed as well?

Okay. Alright. Well, I'm thankful that the patient had you, and you're an expert in women's HealthCare, and I'm I'm ready to get into this topic. Let's do it.

So first of all, perimenopause has been in the news a lot lately, right, from Oprah. Right? She did that special. Well, I don't actually remember if that special was just on menopause or if it included perimenopause or not. But it's not something we've really talked about that much, at least not for me as I've aged into this stage of life. So what exactly is perimenopause?

So perimenopause is the transition from when women have regular normal menstrual cycles to menopause, and the definition of menopause is no bleeding at all for one year.

So it it doesn't just go from regular cycles to nothing.

Mhmm.

In most cases, there are changes in the menstrual cycle.

Initially, they actually get closer together. So if your periods are every twenty eight days, they may become twenty five days, twenty two days, so closer together.

Lucky for us.

And then we, stop having, regular cycles, and we may miss one or two or three months. And so things will be irregular.

That can last for many, many years. Perimenopause typically starts four years before the final menstrual period, and the average age of menopause in the United States is somewhere between fifty one and fifty two years.

In addition to the irregular cycles, there are symptoms that women experience, including hot flashes, night sweats, sometimes difficulty sleeping, sometimes mood changes like irritability or depression, and vaginal dryness. Those are the main symptoms that can occur. Not everyone has all of those, and they can come and go. So when your periods are regular for a few months, you might have no symptoms at all. But then if you miss two or three months, that's when the hot flashes and night sweats might kick in.

And did you say perimenopause lasts for four to five years sometimes?

Or Yes.

But it's extremely variable. I mean, I have seen women in their early forties who have some perimenopausal symptoms and actually don't go into menopause until fifty or fifty one.

Wow. That's that's a long much longer than I thought.

It's it's a transition, you know, and I always like you, I was like, well, you hit menopause and everything. You know? I I had no idea there was this long sort of runway towards towards this change in life and the ups and downs from it. Suddenly, things start to change, and you're like, what's going on? Exactly. Exactly.

So do we so do typically patients reach in the menopause phase and then look back and say they were going through perimenopause, or do we talk like, do the patients talk about it before? How does that I see. Good workout?

More and more patients are coming to seek help for the perimenopausal symptoms because they realize that there's something changing and they don't like their new quality of life. Yeah. And I really focus on quality of life. For example, if cycles are irregular and it's really bothersome to the patient because they don't know when to expect their next period, we can talk about different treatments to make her periods regular and predictable.

If, the symptoms are hot flashes, night sweats, there's a lot of different treatments that we can talk about. Some are just herbal over the counter. And then addressing mood symptoms, anxiety, depression, Some women have significant mood symptoms in perimenopause even if they've not had any mood problems in the past. Of course, if you do have a prior history of postpartum depression or, depression or anxiety that have has been treated, you have a higher chance of having mood symptoms in perimenopause.

But those need to be addressed, and sleep is huge.

If you're not sleeping well, it's easy to be irritable and, depressed. So I think new sleep onset issues can definitely occur in the perimenopausal transition.

And if they're adversely affecting the patient's quality of life, that's when we need to talk about what what can we do to make things better.

Do you think more people are talking about it now just because of Social media. Social media.

I know.

Why didn't we talk about it before? Just did we always do it just in our own circles of friends?

I think in elite circles. Yeah. I think social media has really brought this to the forefront and, increased the attention, that it's getting in in just women's lives in general.

You have to take everything with a grain of salt when you see on social media and everything like that. But I was grateful when I started seeing things, and I'm like, oh. Oh. I'm not alone. Oh.

This may be normal.

This this might be real. I might actually be feeling something here.

You look too young for perimenopause. I appreciate that. But Yeah.

So you're doing something well. So it's the it's the moisturizer.

Good genetics. It's the moisturizer. And the moisturizer.

Well, you talked a little bit about the symptoms already. Is there a test, or is it all symptom related?

So there is not a test. And I know there's a big push, on the Internet and social media to, quote, have your hormones checked.

It's really fascinating to me in this menopausal transition, perimenopause.

If I were to check someone's hormone levels, I can check them one month, and it looks like they're nowhere near menopause.

Literally, I can check a month or two later, and it looks like they've been in menopause for ten years. So there's such variability that it does not help us, determine anything. There's not a lab test that we can do that'll say, oh, your last period is gonna be two point five years from now.

Mhmm.

So it's really all symptom based. It's it's what's happening with your menstrual cycles and what associated symptoms are you having, and are those symptoms bad enough that they're affecting your quality of life?

Okay. So because there's no test or anything like that, what is your advice to women who may just not feel right? Something's off.

Talk to your provider. Don't dismiss the symptoms. Like, really keep track of how you're feeling and what's changing.

Some of the changes may be okay. Like, if you're having feeling warm in the middle of the night here and there, but you're still sleeping well and functioning well during the day, you might notice it, but it's not a big deal. But if you are all of a sudden not sleeping well, awake at three in the morning for two hours, and this is a consistent problem, see your provider. There's so many great options to make your quality of life better.

And don't let them dismiss you. Right? If, like, if they do wanna test and they see everything's fine, well, maybe it's not. So Right. Ask questions.

Right. And and and focus on the symptoms Yeah. Not just lab results.

Okay.

So what can what can they do in terms of, like, managing going through perimenopause, while going through that transition? You know, like, you mentioned some of the, symptoms that they're having. Is there some home remedies they could do, or what are some of the recommendations as a provider you would tell them?

The biggest symptom I hear is hot flashes or night sweats.

And if they're moderate but not severe, then I usually have them try black cohosh over the counter. The brand I recommend is called Remifemin, and it's because that's the one that had been studied in the literature. So I feel like it's very safe. It works in some women. Some of the studies show it doesn't work, but individually and anecdotally, I definitely think in some women, it has. There's a really cool new over the counter herbal supplement called Thermella, and it has a combination of it's really weird. Curcumin, a blue green algae called spirulina, and decaffeinated green tea extract.

Interesting.

But that works on a certain pathway called the neurokinin inhibitor, and it works very well. So that's that is now, over the counter. It's new, but it works really well, usually within a couple of weeks. So I feel like that's extremely safe.

Okay.

And those are things people can do without even, seeing their provider.

Okay.

Now if that doesn't work or they're having severe symptoms, then when we talk in the office about different treatment options, there are low doses of antidepressants that we can try, depending on their other symptoms.

Gabapentin is a nerve, nerve pain or a seizure medicine at a very low dose. It can help hot flashes.

There's a a soy isoflavone extract called Genistein. It's it's called Fosteum plus.

That is a prescription, but I feel like it's a very safe supplement, and that, helps hot flashes and also increases bone mineral density. So especially in women who have osteopenia or at higher risk for osteoporosis, that's a great option. There's an overactive bladder medicine called oxybutynin can which can help hot flashes.

That's a lot of options.

I know.

I've never asked talking through that.

I'm sorry.

These are long conversations. I know. Yeah. And then, definitely hormone replacement therapy is an option, and that is really the one that helps with most, if not all, of the main symptoms of menopause.

So we're really focusing on perimenopause. But as patients transition into menopause, they can have brain fog where they're just having trouble finding words and remembering things, joint pain, and hair loss. Estrogen replacement therapy really helps the most with all of the symptoms. Mhmm.

So that may be a great option for most women, but, definitely, your provider would need to look at your medical history and your family history and determine if that's right for you.

It sounds like everything is so individualized.

Everything varies.

One of my questions was and I think you answered it already, but not everybody experiences it the same.

It changes just because you maybe had a history of a certain type of period or menstrual cycle that could be out the window Yes.

As you transition too. So change. And you have to figure out how do you adapt your lifestyle Yes. To adjust to those changes.

Okay.

Yeah. The only part is there's some, over the counter options for, you know, hot flashes or some of the symptoms that they're going through. And then the other part is you need to talk to your provider about your specific body and your specific medical history of what fits best for you. Yes. And the good thing while assuming we're starting this journey at the perimenopause phase as they're entering menopause, they could use similar strategies to go through menopause?

Oh, absolutely. Yeah. Absolutely. And then for sleep, I definitely, we need to optimize sleep hygiene, like making good decisions about not drinking caffeine late in the day and making sure you're in bed conducive to sleep for seven or eight hours, and minimizing, like, blue light exposure.

Or chocolates.

Exactly. Exactly.

But I I do have a lot of patients, that I recommend an extended release melatonin to a controlled release or extended release. One to three milligrams at night, I feel is is very safe to take, to help with sleep. And if that doesn't work, then definitely hormone therapy, sometimes the antidepressants or gabapentin low dose will will help.

And I often prescribe a super low dose of a old antidepressant called trazodone, which is very safe and inexpensive, not addictive. Mhmm. And that is a great option to help women sleep.

It's nice to know there's options out there. Lots of great options. And underscoring the underscoring what you said of talking to your provider physician, if you're, you know, having symptoms or just struggling through this, don't tough it out. Talk Don't tough it out. Talk to your provider and there's there there are options.

Yes. And make sure your provider's listening. Like you said before, make sure here, I'm having a hot flash.

I you know what? I was sitting here thinking to myself Is it warm in here?

Or is it okay. Okay. So I just thought. Yeah.

Talk about hot flashes.

I have warm though.

It's it's it's it's going it we're speaking it into existence.

Let's just say it is warm in here.

Yes. Okay. That that works.

Well, since I don't, you know, we're we're sort of sitting here like, oh, there's a lot more options than we thought. Tell us about some myths.

I definitely hear a lot of women come in and say their hormones are unbalanced or they need their hormone levels checked.

And I just wanna educate everyone that in the normal menstrual cycle, there are tremendous hormonal fluctuations. And in perimenopause, even more so. And every time I order a test, my thought is, how is this test gonna change my management?

And by getting a hormone level as, like, a certain point in time, it just doesn't help you make clinical decisions about what how do I treat them. So I really think just focusing on what's happening with your periods, what's happening with your symptoms, and how do we make your quality of life better?

Yeah. Because it's so transient, I I just I I started, like, a little thing in my notes app of, like, what's been going on. Like, oh, I feel this today because I couldn't I couldn't keep track of it because it was changing so much.

So when I just was keep great idea.

I just sorta was like, I'm just gonna keep track of this because I can't remember Right.

You know, a couple weeks ago how I felt and then today. Yep. So that that was actually helpful for me because I was running into a similar my levels are okay.

Like, I had had my physical and It doesn't mean Everything looks great.

That you feel great.

Yeah. But I'm like, but I still don't feel good. Exactly. So I'm like, I'm on the start times.

Exactly. So okay. Good to know. Any other myths?

That's the really big one. I mean, there's a big push for hormone replacement therapy in the media now. Mhmm.

And looking back at the Women's Health Initiative, which was the big hormone study that came out in two thousand two, so so long ago.

Mhmm.

And it was looking at Prempro, which is an oral medicine that had both estrogen and progesterone.

And it was not bioidentical, and it was given to older women.

And they they showed in that study that there's an increased risk of heart attack, stroke, breast cancer, and blood clot in the leg, at least after five years of use. Well, things have changed dramatically, and now we do bioidentical, meaning the estrogen and progesterone that we give are the exact chemical structure of what your ovaries used to make.

And the estrogen that is absorbed through the skin, so transdermal, it bypasses the liver. So we think it does not increase clotting factors, and it does not seem to increase the risk of blood clot in the leg. The newer studies do show that it does probably doesn't increase the risk of heart attack or stroke or breast cancer. Right. So I feel, like, very optimistic. Now we need more data how we're giving these bioidentical transdermal hormones, in terms of risks and benefits long term.

But I think more and more, the safety is gonna be shown.

Okay. Well, I I didn't actually put this as a question for you today, but I'm glad you kinda brought it up where you said, you know, we need more data. But I'm excited to see kind of some of the, advances in some of the medications and the fact that we're talking about it. Anything that we can look forward to in the next couple years in women's health?

I do wanna bring to light one of, a new drug that has been FDA approved for hot flashes, and it's called Veozah.

It's been out for about a year, and it works in this, neurokinin inhibitor pathway.

It is very, very safe and very, very effective. And so it has been a game for a lot of women who really struggle with hot flashes and night sweats, and nothing else has worked.

Oh, wow.

So I'm super excited about that. It has a extremely rare chance of liver toxicity, and so women have to have their liver, enzymes checked here and there for the first year or two of use.

Okay.

But it's extremely effective. The only issue is insurance coverage.

Yeah.

Well, it sounds to me as if the more we talk about it, the more attention it'll get and the more awareness people will have and finding these different things and at least just talking about it to be able to manage the symptoms better.

Exactly.

What can we as women do to prepare for this stage of life? Like I said, I I don't know.

Or how can I prepare my loved one?

What I'm gonna say is the same for men and women. I don't take care of men, but it's gonna be the same advice. And it's really just optimize your health. Do what you can to live a healthy lifestyle.

So the recommendations for exercise are a hundred and fifty minutes of moderate to vigorous exercise a week, three hundred minutes a week if you're trying for weight loss. And I think strength training is very important as part of that two to three times per week.

I think more and more, diet plays such a role in our HealthCare, and mostly plant based is probably the way to go. I really, really think people need to minimize processed foods and sugar. And then the other part that's so important, just as we age, all of us, is staying active socially.

So those three things, physically moving and being mindful of what you're eating and then staying mentally and socially engaged in society. I think all of that really is the best that we can do.

Everybody's metabolism decreases as we age, and so if we're not constantly bumping up our exercise or decreasing our calorie intake, everyone's gonna gain weight.

Yeah.

And so I think I mean, it is unfortunate that in menopause, there is a change in where fat cells are distributed. So it's more around the abdominal area and around the internal organs.

But we can really fight that. One thing that's amazes me, it's pretty sad, but how few calories we actually need to live compared to what we're used to eating. If you enjoy, let's just say, french fries, please eat them once a month instead of three times a week.

Yeah. Yeah. Yeah. Yeah.

Yeah. Exactly. Like, enjoy your hamburger just in moderation.

I like that.

As we age, our metabolism changes, and so we have to do a little bit more Or a lot more.

Or a lot more. More. Yes. Yeah. Anything else you wanna add, Dr. Young, that we might have missed?

I do wanna also mention that genetics plays a large role in menopause. Oh. I had one patient who was sixty five and still having periods. So she wasn't even in menopause at sixty five, and her mom did the same thing.

Oh.

And then I have patients who are forty one, and they're in menopause. Some of it can be related to genetic factors. Menopause is considered abnormal or premature if it's before the age of forty. So if you have menopause before the age of forty, there's different tests that need to be performed to just to make sure there's not something else going on.

That's a new fact.

I never you know?

Having the discussion with your, primary care provider, you know, ensuring that you discuss your family, you know, the medical history.

Yeah. Having that Yes. The family history is is really important.

And then smoking makes you have an earlier menopause. Oh. Having a hysterectomy, you tend to go through menopause one to two years earlier.

And having children tends to delay menopause a few a few years later.

So So individual then. It is. Very individual. You know? And the more we do this podcast, the more I go. It's everything is so individualized. And, again, just underscoring the importance of having a strong relationship with your provider and finding one that works for you and you can have a good partnership with and talk to.

Absolutely.

Alright. Well, thank you so much for coming in. We're gonna have to have you back to talk about fibroids.

Oh, please do. It's some of the favorites.

Yes.

And some of the the Abnormal bleeding Yeah.

And fibroids.

And which is probably more common than we think. So we'll have to have you back to talk about that.

I'm not talked about enough.

Anytime, I thought.

Alright. To find out more information about Dr.Young, you can visit adventisthealthcare.com and click on find a doctor to search. We'll also put more information in today's episode's show notes. We'd also love to hear from our listeners. You can let us know if you like the podcast by leaving a review, or you can email podcast at adventisthealthcare.com and let us know what health care topics you want to know more about. Don't forget to subscribe to the podcast so you get new episodes. Thank you, and be well.