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June 14, 2021

Hormone intelligence with Dr. Aviva Romm

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On this episode, Dr. Aviva Romm and I discuss her new book, Hormone Intelligence.


Let's Say Hello

[00:01:04.370] – Allan
Hey, Raz. How are you doing?

[00:01:06.080] – Rachel
Good, Allan, how are you today?

[00:01:08.300] – Allan
Good. I get a chuckle out of that voice when we go on Zoom here to do these recordings. Now, when you record on Zoom before you just hit record in your recording. But now there's this female voice that wants to tell everybody on the call that they're being recorded and and then when we get off the recording it does the same things. Call is no longer being recorded. It's just funny because it's in the headphones. It's really, really loud.

[00:01:33.470] – Allan
So it's like we're having a nice conversation, good conversational tone, and all of a sudden this woman's yelling at me. Recording this call.

[00:01:41.300] – Rachel
Yeah. I've been warned.

[00:01:43.130] – Allan
And I have been recording this call because this is our welcome for this podcast. And how are you doing, Rachel?

[00:01:50.480] – Rachel
Good, good. Things are great up here. We've had some beautiful summer days. It's nice to get out, spend some time outside. Our vegetable gardens are growing really well. So, yeah, it's a perfect time of year up here.

[00:02:03.410] – Allan
Yeah. You have your little animal kingdom with your pond.

[00:02:06.350] – Rachel
We do.

[00:02:07.610] – Allan
Posting the other day with a snake and a frog. Or snake versus frog. Is that what it was?

[00:02:11.990] – Rachel
Yeah. And he was back. My husband Mike just saw him the snake again today and he had a bulge in his belly. So I know he ate another one of my frogs. Need to make..

[00:02:23.090] – Allan
maybe he's also eating rats.

[00:02:25.580] – Rachel
I would like to think that.

[00:02:28.250] – Allan
It was a rat. We're gonna call it a rat. Lacking any other evidence to the contrary. It was a rat.

[00:02:34.610] – Rachel
Makes me feel better. That would make me feel a lot better. How are you doing?

[00:02:39.890] – Allan
I'm good. Yeah, we actually have a new houseguest. It's a crab. It crawled into the kitchen late last night, so I was there shutting everything down and I'd like you know, we leave things open because we don't do the air conditioning for most the house. It's just our bedroom. It's air conditioned. When I was walking in and right there by the refrigerator here's this crab and it's not a huge crab.

[00:03:01.970] – Allan
You know, it's probably about the size of my fist. And I'm like looking at the crab. I'm like, I'm not going to get you to walk out of here right now. And he just looked at me with his pinchers up and I was like, OK, so I went, got a pan thinking OK, I'll just try to go scoop him in a pan and then toss them out the back. And then he ran back behind the refrigerator.

[00:03:17.630] – Allan
And I'm like, I'm not moving the refrigerator.

[00:03:20.000] – Rachel
Oh my gosh.

[00:03:21.470] – Allan
Clean up after yourself and we're cool. And so I went back to bed. Apparently he's still out and about. And so my wife saw this morning, so, yeah, we have a pet crab now. I haven't named it.

[00:03:32.630] – Rachel
I'd say. It's so funny.

[00:03:36.200] – Rachel
Well, I hope he doesn't stay too long.

[00:03:38.600] – Allan
Yeah, well, Buster is pretty excited to have a houseguest. And so if I think of Buster, Buster has an opportune meeting with him. Yeah. Not going to go well for the crab or I don't know, maybe the crab, the upper claw and Buster will not want to deal with crab.

[00:03:56.870] – Rachel
Well, oh boy.

[00:03:59.360] – Allan
So I have wild kingdom in our house too. Just like a different set. I think the mammal's going to win this one.

[00:04:05.520] – Rachel
Oh my gosh. Well, good luck.

[00:04:07.670] – Allan
Yeah. All right. So let's talk to Dr. Aviva.

[00:04:11.240] – Rachel


[00:04:48.500] – Allan
Dr. Aviva, welcome to 40+ Fitness.

[00:04:51.840] – Dr. Aviva
Thank you for having me here. It's a delight.

[00:04:54.540] – Allan
Now your book, Hormone Intelligence: The Complete Guide to Calming Hormone Chaos and Restoring the Body's Natural Blueprint for Well-Being. I've read a few books on this topic, and obviously I don't have to deal with women's health issues myself, but I am a husband and I'm a father. So it is something that I try to stay at least somewhere of. And being the host of this podcast, I've had several authors on to talk about menopause, hormones, and women's health.

[00:05:22.710] – Allan
This book is maybe the most comprehensive complete guide I've ever read. You didn't leave anything out and you really kind of I don't know that there's a question I've ever would have had with my wife and all the things that we've dealt with over the years and my daughters that wasn't answered in this book somewhere.

[00:05:43.350] – Dr. Aviva
That makes me so happy to hear I was truly driving my publisher crazy because they would like, Aviva, this is too long. We have to shorten it. Like, yeah, but if a woman comes in, she's going to ask this question and they said, well, that's the problem. And the beauty is that because you're a physician and you're actually working with women, not just, you know, how a celebrity writing a book, you already anticipate the next question.

[00:06:05.770] – Dr. Aviva
So I'm glad that came through in a positive way.

[00:06:09.110] – Allan
It did. It did. It's you know, so it's an in it all. It all fit together in a way where, you know, as you're reading through it, it's both informative and then it's this reference guide. You just you put it on yourself and you know, when you start feeling something's going on, a hot flash or, you know, your periods are too painful and you're trying to understand what's going on, pull out this book. And there's a section in the book specifically with protocols for how to deal with that particular issue.

[00:06:37.230] – Allan
So it's like I said, really the most complete book I've seen on this topic. So thank you.

[00:06:43.650] – Dr. Aviva
Thank you. I'm hoping it'll be part self-help, how to and part one of those books that you do have on your shelf year after year and you kind of, you know, this may come up or that may come up and you go to it or you're just going through normal transitions in your life and you just want to hear, OK, well, what can I expect? What can I do? And I kind of have this dream that it's that book that mom's always wanted to actually have something to pass onto their daughters that's meaningful as well. Say, OK, you know, this really helped me.

[00:07:11.370] – Dr. Aviva
And now here it is to really help you.

[00:07:14.140] – Allan
Yeah. I mean, like I said, with my daughter's taking her to the gynecologist, going with my wife, to her appointments and these things, there were things that came up that I want to talk about during the podcast that I was just like, I really wish I knew this going in because I would have asked smarter questions. And that kind of leads me to the first thing is you start the book and you're talking about these tips for dealing with Medicare.

[00:07:37.590] – Allan
And it's so interesting because we don't want to be advocates for ourselves sometimes. And from reading your book and kind of just general knowledge, women especially are kind of put into this. Oh, well, that's just normal girl stuff. You know, go deal with it. But when we go to our doctor, we have to do a few things. Can you talk about those six tips for better medical care?

[00:08:00.140] – Dr. Aviva
Yeah, absolutely. I don't have the six in my book, kind of in my mind in order, but I can give you the tips and why it's so important, you know, on an individual basis. I've really honestly, in all my decades of working in women's health and being a physician and studying with, you know, numerous mentors and through my medical training, I've never met a physician that wasn't well-meaning and well-intentioned and didn't care about their patients.

[00:08:25.190] – Dr. Aviva
But the system of medicine is based on a lot of inherent biases that most physicians never learn about or think about. And a lot of those biases, unfortunately, play out in women's health. One of the biases and it's misinformation is that, you know, as women, it's just normal to have miserable periods to blow through boxes of tampons, you know, because you're having heavy bleeding or to be bent over with period pain or to have to take ibuprofen for a day, a month or three days a month or, for PMS to just make you miserable.

[00:09:01.070] – Dr. Aviva
And then things like chronic pelvic pain, weight gain, depression over things that can have to do with polycystic ovary syndrome, or there are a lot of these biases that end up causing women to go to the doctor and being told by their doctor, oh, that's just normal. And what we're taught in medical school is, OK, it's normal, but let's just give the pill or let's just tell her to take more ibuprofen or let's give her an antidepressant.

[00:09:30.470] – Dr. Aviva
And while those things may be helpful at times, one, they have side effects that are just, you know, unfortunate kind of byproducts of taking pharmaceuticals on a regular basis or even on a short term basis, but they also don't get to the root of the problems, things like chronic inflammation, stress, things that we can change in our diet that we never learned about in medical school. So there's that one set of biases that this is just normal. Just take a pharmaceutical.

[00:09:59.100] – Dr. Aviva
So when you go to your doctor and you ask for something different, hey, I heard about this herbal hey, can I try this diet or I read about that a lot of women get dismissed or an eye roll. And I've had many patients who have been told something like, well, where did you get your medical degree, doctor google? There's this very dismissive attitude. Also, physicians have kind of learned as part of the institutionalization of medicine that we only have seven to 15 minutes to spend with any given patient.

[00:10:31.430] – Dr. Aviva
And so we tend to get right to the symptoms, not really hear what's going on in a woman's life, not really ask the questions. And when a patient starts asking questions, it can really cut into the time that we think we have to get all this information from them. And so patients who start to push back or ask questions or look for alternatives are sometimes labeled as difficult patients. So when you go to the doctor's office and you've got concerns and a lot of women don't even go to the doctor's office for these concerns because they've been treated with dismissal before, or they just think these symptoms are normal.

[00:11:07.430] – Dr. Aviva
But when we do go in, we really need to be prepared and preemptive in order to get the answers that we need. So one of the things that can happen to any of us when we go to the physician's office, but especially to women, is that there can be a huge power differential. Right? You're going in. You're vulnerable because something's going on in your body that you're concerned about. You're worried about. You're already thinking it's the worst thing it could possibly be.

[00:11:34.730] – Dr. Aviva
And now you go in and you go into the waiting room. You know, you're in the waiting room waiting for however long. Then you finally get to your doctor's office and the nurse comes in and says, here, put this on. And it's a little Johnny with the back flapping open and nobody feels empowered. They're wearing one of those, but on top of it, then your doctor comes in and is dressed up in their in their office professional clothes with their white coat and their stethoscope.

[00:11:58.790] – Dr. Aviva
And all of a sudden this power differential becomes really intimidating. So one of the things that I tell people go into the doctor is keep your clothes on until the part where you get the exam, because the first part is usually the talking to. Right, the conversation. Keep your clothes on, have the conversation first, and then when it's time for the exam, you can have your physician step out and get into your Johnny and then get that part done.

[00:12:25.460] – Dr. Aviva
So that really helps you be heard. That's really important. Another thing is before you even go to your medical appointment, write down all of your concerns. Really great like a script card for you up yourself. It can be just bullet points. But when you get into that moment and you're in that power differential, even if you've kept your clothes on and your doctor is clearly in a rush, and we know that on average, medical doctors interrupt their patients after 60 seconds of their patient talking.

[00:12:55.580] – Dr. Aviva
So you've got 60 seconds and then your concerns aren't hurt anymore. So when you're in that pressured environment is very hard to remember to say, oh, well, I wanted to talk to you about this pain I'm having every month, let alone I want to talk to you about this vaginal itching that's really driving me crazy. Right. That's even harder to say. So have your script card there and say to your doctor, I really want I know this is weird, but I really want to use these notes I brought to make sure that I cover all the things that are really important to me.

[00:13:25.590] – Dr. Aviva
Also trying to get all of that squeezed in when you're going in for your annual exam can be really tough because, again, a doctor only has a certain amount of time. They have things they're supposed to check off their list to ask you for their own, you know, medical licensure and all of that to stay safe that they want to ask you, are you depressed? Is this going on? Is that going on? Maybe hard to get to your actual concerns.

[00:13:49.530] – Dr. Aviva
So if you're having a concern that is intimidating, you may forget to ask it. Having that little cue card there with you really helps to make sure you're getting through that. But having an appointment set up separately just for those concerns can really make a difference. Another really important point is to bring an advocate with you. And it sounds like, Allan, you've gone to the doctor with your wife and you're with your daughter to the gynecologist.

[00:14:15.600] – Dr. Aviva
And that's so important for someone to know there's someone out in the waiting room for you. But obviously, it's going to be a little more awkward for a dad to go into their daughter's gynecology appointment with them. But it's really important for women to have someone there, especially if they get intimidated in that setting who can kind of elbow them and nudge them and say, remember, you wanted to ask your doctor about that. It just gives you a lot of confidence and support and it makes sure that you're getting your concerns heard and your doctor's more likely to be on their best human behavior if there's someone else in the room as well paying attention.

[00:14:52.740] – Allan
There was one thing, though, that you put in there that I think was really important for the men to consider here is that there is this power structure you were talking about, and we need to be an interference to that and making sure that our wife or girlfriend is being heard versus being in there and saying, but the doctor said, suck it up. And, you know, that's not the approach we want to have. But sometimes you end up on the wrong side of the fence defending the wrong issue.

[00:15:22.120] – Allan
So go in there with your eyes open, know what your wife or significant other know what they're dealing with so that when they're asking the questions, all you really want to know, the doctor is hearing her. And then is giving a response, and she's thinking the response is reasonable based on her experiences, because you're not experiencing that. So that's really, really important to not..

[00:15:45.920] – Dr. Aviva
Yes, in the book. I talk about being careful about bringing in a male partner, especially if it's a male doctor, because it's so easy for the bro thing to happen.

[00:15:54.650] – Dr. Aviva
And the male doctor is like, you know, giving you the look like, yeah, right. She's got this PMS thing going on. I bet it's driving you crazy too like all the like the inside joke stuff. And I've seen it happen. So your point is so important and I talk about that in the book, which is like don't let the bro thing happen. Your job is to be there for her or your partner and to validate her and make sure she is heard and not to, like, partner up and take sides with the doc.

[00:16:21.040] – Allan
Now, there are a few things that you said in the book, and I was like, you know, just they just hum to resonation, as you were saying. And the first thing you said that I thought was just really important for people to hear is that hormones are messengers. If they're not there just in a certain amount at a certain time for just no reason at all, they're there to do something very specific and sometimes not having enough of them or having too much of them is a signal to our body that something else is wrong, not that we need more of something added just to balance it out or there's something going on in our system that's causing that imbalance.

[00:17:02.530] – Allan
And that's what we want to get to the root of.

[00:17:04.840] – Dr. Aviva
Exactly. So hormones literally, as we define them in medicine, are chemical messengers. And I jokingly I think they say someone, don't shoot the messenger. But as women and as men, we're always like, oh, she's hormonal. I'm hormonal. Like, we blame it on the hormones and the hormone imbalances. Or in the worst case scenario, as women, we blame ourselves like there must be something wrong with me or I must be doing something wrong because I feel like crap for my period every month or I feel, you know, doubled over in pain because of my endometriosis.

[00:17:37.900] – Dr. Aviva
And so instead of blaming our hormones and shooting the messenger, what is it that these imbalances, these symptoms are trying to say to us as a reflection of that there is an imbalance going on, like what is the message happening with PMS? What is the message happening? Why are you having these painful periods? And that kind of starts to get under the hood of what some of the answers are to then starting to solve some of those problems?

[00:18:09.190] – Allan
Yeah, I don't think we can get to the answer unless we're actually looking at the problem. And the problem is not the symptom. The problem is, is the underlying issue. And then the other thing you had in there that I think is just really important to take home is that, you know, more and more, yes, doctors will just say, you know, take this pill, get on antidepressants, do this thing, or let's get this hysterectomy, because it's so common that the issues that we're talking about are so common with women.

[00:18:35.410] – Allan
But common doesn't equal normal.

[00:18:38.520] – Dr. Aviva
Exactly, you know, when there's a saying that if all you have is a hammer, you see everything as a nail. And I can tell you from having spent seven years in medical training that we are basically never taught to do anything but give pharmaceuticals and do surgeries when it comes to pretty much everything in women's health, whether it's fertility, something going on in pregnancy or birth, whether it's a mental health problem, another gynecologic problem or menopause.

[00:19:11.790] – Dr. Aviva
And I'm not, you know, as I say, so open mind that my brains are falling out. I think there's an absolute time and place for a pharmaceutical and a medicine and a surgery. And, you know, I think it's also important to meet women where they are. If a patient comes to me and she's like, I really just want to take the pill from my PCOS acne, I'm not going to judge her or withhold that. I'm going to say, look, I just want to make sure you understand the ramifications of taking this.

[00:19:38.730] – Dr. Aviva
And would you be open to possibly trying these things first or instead? To me, it's you know, it's like if you had to kill a mosquito, you wouldn't get out a cannon, you would use your hands or get a swatter or something like that. Hopefully I'm not offending any Buddhists or someone who doesn't kill mosquitoes. But point being, we tend to go after symptoms in medicine with the biggest guns rather than looking at what can we do to maybe reduce stress or shift the diet or add in a particular supplement.

[00:20:16.080] – Dr. Aviva
And there's so much judgment in medicine, all those things don't work. But that's not actually true. Not everything that's touted out there in the natural medicine world works. But there are actually some substantial interventions that are natural, that have been shown to be phenomenally effective. And so most it's like, well, try that first and then if we need to progress to this, that or the other, we always can do that.

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[00:22:49.550] – Allan
My wife was really having some heavy periods and in a lot of pain and, you know, a lot of women will think, OK, that's just normal stuff because it's just so common. But hers was not normal.

[00:23:02.480] – Allan
And we you know, we went into the doctor and, you know, the doctors kind of like, well, you can be on the pill. That would help. And then we finally opted for the ablation. And so she went in for the ablation surgery. And I got called into the room because the doctor was surprised by a fibroid that she ran into while she was in there. And it startled her a little bit and being startled, she startled my wife then my wife is under, you know, a little bit of sedation.

[00:23:28.100] – Allan
So she's not completely there. So they brought me into the room to discuss this. You know, that there's a fibroid, that there's nothing wrong that's normal. It's there. We knew about it, you know, just. It was there. Again, had I known about fibroids and what they're indicative of, I would have started asking a lot more questions. But I didn't. I didn't have this book back then. And so I want to kind of talk about fibroids a little bit because we just went through now having to have that fibroid removed with a hysterectomy because it had gotten so big.

[00:24:04.610] – Allan
It was scary big. When I actually saw the picture was, wow. We even named it Elmer because it was so big. Can you talk a little bit about fibroids and what as an outward symbol of fibroid would indicate is going on with us or with the woman? I'm sorry.

[00:24:26.210] – Allan
Yeah. So, you know, there's sort of like these meta levels of things, right? So fibroids are a result medically of high levels of estrogen. Women post menopause. Once our estrogen levels go really down, fibroids tend to shrink on their own. And we don't have fibroids before puberty because there's no estrogen feeding them. So fibroids are a result of high levels of estrogen and then usually a result also of something called insulin growth factor and other growth factors, which can happen as a result of a little bit of insulin resistance.

[00:24:59.810] – Dr. Aviva
It can happen as a result of just other hormonal imbalances. And so that's the meta level of there's too much estrogen, usually too much insulin like growth factor and maybe some insulin resistance. And then cortisol may play a role in triggering stress hormones that actually feed the fibroids as well. So catecholamines may feed the fibroids and that those are breakdown products of adrenaline and stress. And so that's sort of like the immediate medical. We know that from an upstream perspective physiologically or pathophysiological.

[00:25:34.370] – Dr. Aviva
We know that. And then there's sort of like the next level question is, what's causing those things? Why did your wife have high levels of estrogen? Why might she have had elevated levels of insulin like growth factor? And then we started to get to even a level above that, you know, as upstream as we can go, if you will, which is we know that environmental chemicals, herbicides and pesticides, for example, or plastics that leach out of our Tupperware's that we all ate out of growing up or may still out eat out of.

[00:26:01.100] – Dr. Aviva
Now, the plastic water bottles that were so popular in the 80s and 90s that we were all drinking out of. Our cosmetics and these things where you may just be getting nanoparticles like the most tiny little particles of these different environmental chemicals, but they act as estrogen disruptors. So they actually are contributing or adding to our estrogen load. And when you think of tiny little nanoparticles, well, you only have nanoparticles of estrogen anyway. It doesn't actually we don't have that much.

[00:26:31.810] – Dr. Aviva
It's is very potent. And when it finds to our receptors so environmental triggers can cause these high levels of estrogen, chronic stress can cause those high levels of stress hormones. And it's not that your wife is necessarily some stressed out person either. It's just the chronic normal stressors that we're all facing 24/7. And then there are a lot of dietary factors. One, the packaging that our food does come in which leaches plastics into it. But also most of us aren't getting the amount of fiber we need.

[00:27:04.340] – Dr. Aviva
You know, paleo diet was really popular and it still is. And it's not something I subscribe to necessarily. But we do know that our paleo ancestors got about 100 grams of fiber every single day. We know from the American Cancer Society that we should be getting thirty grams of fiber a day just to prevent colon cancer, like just basic good health for colon cancer prevention. The average American is getting fifteen grams of fiber a day, but fiber is critical for maintaining estrogen balance.

[00:27:33.020] – Dr. Aviva
So there are a lot of factors that go into why so many women are experiencing fibroids. Then from a medical level, there have been some really significant studies looking at how women with fibroids and other gynecologic concerns, heavy periods, et cetera, even women in their late 20s and 30s, let alone in our 40s and 50s, go in for treatment. And particularly fibroids is one big area. This happens and end up with a hysterectomy without their doctor ever providing them with the list of alternatives that they can and should be able to do long before surgery.

[00:28:14.570] – Dr. Aviva
And when I'm talking about alternatives, I'm not talking about herbal medicine or detox or something like that. I'm talking about pharmaceuticals. So one study, for example, done in the state of Michigan, and it was a multicenter study, meaning they looked at patients, they gathered data from patients at five different major medical centers. And aggregated that data and found that only a small percentage of women who were going in for a fibroid or another reason for a hysterectomy that was non cancer, cancer would be an appropriate reason, but only a small percentage were ever told that there were other medical things that they could do, including medical things they could do to shrink the fibroid, so that if they did ultimately still need to go into surgery, they can have the fibroid removed and not their whole uterus removed.

[00:29:03.070] – Dr. Aviva
So there's a lot of lack of knowledge among physicians that there are alternatives. And not to be callous, but I am a doctor, so I'm speaking for my own profession. There's a huge amount of financial incentive to choose to do a surgery over recommending a pharmaceutical. It just it's night and day when it comes to what ends up in your pocket at the end of the day. And it's not just your pocket, but it may be the hospital you work at gets much more money from you having more patients get surgery so that there's a lot of incentivization that's built into the system that we don't really

[00:29:42.980] – Dr. Aviva
Think about or know about as individual patients, and it sounds almost conspiratorial when I talk about it, but it's actually very real. So, you know, it comes back to what we were talking about before, which is how do you manage your own medical care? How do you be the CEO of your own health? And I think it's really tough. You know, I think as women, as human beings, we shouldn't have to be. We should be able to go in.

[00:30:08.120] – Dr. Aviva
You know, when you go to your car mechanic, you don't have to know everything about your car to make sure your car gets cared for properly. You don't have to research about your carburetor. You hope that your mechanic knows what they're supposed to do and does it. But when it comes to heavy bleeding and whether you should get that hysterectomy or not, first of all, it's terrifying because sometimes the word cancer is tossed in there even when there's no cancer.

[00:30:33.200] – Dr. Aviva
But like, well, if you do it now, then you have to worry about cancer later. Well, OK, I'll take that. I'll take door number three, you know, and if you're not told that you can use Generation inhibitors or other pharmaceuticals to shrink a fibroid, how are you supposed to read that? You know or learn about that one? Half the words aren't even that pronounceable. And there's so much noise on the Internet.

[00:30:57.410] – Dr. Aviva
Where do you even go and trust? So I think it gets really the burden ends up falling on the person who's got the problem to sort it out. And then you go to your doctor and you're like, well, can I try this medication first? And they're saying, well, where do you get your degree, doctor google? You end up just shutting up and going in for the surgery. And I'm not saying that the surgery is wrong.

[00:31:16.220] – Dr. Aviva
I've sent patients with fibroids and for hysterectomy too at times, you know, they're just they're anemic. They're exhausted, they're bleeding. They're peeing all the time because the fibroid is so big, it's sitting on their bladder or sitting on their bowels and they're constipated. Sex hurts. They have pelvic pressure all the time. So there's a time and a place for sure. It's just that we're jumping to that as step number one when it should be step number five.

[00:31:39.710] – Allan
Yeah, and that's one of the cool things about this book, is it does give us some tools to understand the problem. Better to ask the right questions and know that there are alternatives because you discuss them very clearly in the book. The other one I wanted to get into because, you know, women were in their 40s and their 50s. They go through this period of time. It can be three years. It can be eight, almost 10 percent, I guess.

[00:32:01.910] – Allan
But it's this perimenopause period of time, and it's when things are changing. And you said you said something that was just actually kind of kind of funny and little brilliant when you said we should celebrate that the same way we celebrate puberty. It's another phase of life. It's an interesting phase for a lot of women. And as you kind of put it, it's that point where, you know, I don't want to use language, but just we don't have you can kind of let go a little bit.

[00:32:32.300] – Allan
You're wiser, stronger, more powerful person. And you can own this. You can own this process. Can you talk a little bit about perimenopause, some of the basics of how someone should approach this and what they should be looking for as far as if things are going well or not going well?

[00:32:52.160] – Dr. Aviva
Yeah, so you know, as young girls, right, were 11, were 12, I mean, it may be a little intimidating to go through puberty.

[00:33:01.400] – Dr. Aviva
And it can feel like a roller coaster, of course, but we're excited because we're becoming women. It's something we look forward to. It gives us new privileges in our life, new things that we're allowed to do. And then so that's one big life transition. Then when we become mothers, that's hopefully celebrated. You know, you're welcomed into the Mom Club when you hit perimenopause. You know, the way it's described in our culture. You know, just because our estrogen is declining doesn't mean we're going downhill.

[00:33:33.290] – Dr. Aviva
But it is like it's been described as over the hill. Well, the only thing over the hill is downhill. Right? Our grandmother's house, I guess. But it's downhill. And we're historically considered not sexy anymore. Not fertile anymore. Kind of washed up. Now, I think that so many women are changing that paradigm. You know, when you think about it, like Halle Berry, Jennifer Lopez, Julia Roberts, I'm just thinking of a few women like women who would sort of.

[00:34:04.580] – Dr. Aviva
Penelope Cruz and Salma Hayek, I'm just saying, you think of the women who we would undoubtably you'd have to be blind to not think they were hot, sexy women who are still considered hot, sexy women who are now in their 50s. And I think about thinking about it that way. The paradigm is changing and half of women in the US are now 50 or over. But internally, psychologically, and have just gone into menopause myself a year ago.

[00:34:31.040] – Dr. Aviva
So I'm solidly on the other side of it. I'm turning 55 this year. You know, if I could curse, I would say it was a mind, something that starts with an F to go through menopause. In our culture, we don't necessarily have that. Oh, now I'm a woman or we don't necessarily have that. Now I'm a mom to look forward to. It's like now I'm what fifty five are now I'm older and I'm middle aged or, you know, all that stuff.

[00:34:57.560] – Dr. Aviva
And now nobody's looking at me. They're looking at my daughter when we walk up the street together. So you really have to be willing to embrace a new way of thinking about your body, a new way of thinking about yourself. And it's also a time in women's lives where their life definition may be changing. Right. It's a time when often our children are finally going off to college or depending on how old you are getting married or having their own children.

[00:35:25.320] – Dr. Aviva
So now you're not just you, you're grandma. And that can really start to affect your self concept if we think about a certain age in a very old fashioned way. But if we think about going through this transition, as Helen Mirren has a quote, which I said in my book, which is basically, you know, if there's and she's in her 70s, you know, if there's anything I would tell my younger self is to not give enough a lot more often.

[00:35:52.130] – Dr. Aviva
And I think there is something liberating about walking into this phase of our life, feeling really empowered and looking at what we've accomplished and looking at all the met, you know, the sort of like massive skills we've accumulated at this point. And often, you know, that maybe you were a stay at home mom and now your kids are grown and you have major, you know, social management skills and time management skills and you've raised adult human beings.

[00:36:18.260] – Dr. Aviva
Or it may be that you're at a certain point in your career, which may be quite accomplished at this point. And I think that we're also at a stage where because we're not sexualized in the same way, it does give us room to redefine what sexy means to ourselves. And what does that mean to be sexy for myself? What does that mean in a bigger context of life? It's not just about reproduction, it's about actually full ownership of ourselves.

[00:36:44.150] – Dr. Aviva
So I think if we can embrace this new experience, it can feel really empowering. And so then if you are going through some physical symptoms, they're easier to appreciate. But interestingly, some studies from the sociology and anthropology world have shown that when we enter menopause with more embracing attitudes about it, we actually have fewer physical symptoms. And we also know medically, when you have more stress, which can happen from being really stressed out about your stage in life, we have more hot flashes.

[00:37:17.060] – Dr. Aviva
So it's a win win to to reframe this time of life. How do you know things are going well? Well, when we enter perimenopause, we can start to have really irregular cycles. And as you shared from the book, you know, perimenopause can happen for up to eight years before we're going into menopause. So from a medical perspective, you shouldn't enter menopause before age forty two. If you do, that's considered premature or early menopause and that can have some medical consequences.

[00:37:45.590] – Dr. Aviva
You might need hormone therapy to support your bones in your heart, etc. But any time in your 40s that you start experiencing some changes in your menstrual cycle, which can be you skip some periods once in a while, your periods get further apart, your periods get lighter, they may be heavier on occasion. That's actually all normal. You may experience some more mood changes that may hearken back to when you were a little bit, you know, in puberty, your hormones are going up and down.

[00:38:18.170] – Dr. Aviva
You may just experience some different shifts. You may have PMS when you never had it before. As estrogen drops, you may even experience migraines if you've never had them before. Any symptoms that you're having then are mild, not really interrupting your life. And you're kind of going, huh, that's a little different is usually a normal symptom of menopause, which shouldn't be happening is miserable hot flashes day in and day out or hot flashes waking you up all night or several times a night.

[00:38:47.360] – Dr. Aviva
Anything that's making you not sleep all the time and exhausted, you should not be having, heavy like, you know, just gusher menstrual cycles. You shouldn't be having really, really heavy periods. You shouldn't be skipping periods for more than a few months in a row. Until you actually get into the year where you're going to stop, so menopause is actually defined as one year of not having a period. So let's say you don't have a period for eight months and then you have a little vaginal bleeding.

[00:39:16.490] – Dr. Aviva
You're not in menopause. It starts over again another year. But once you've not had a period for a year after that, you shouldn't have vaginal bleeding. So if you have vaginal bleeding after that, it's important to go to your gynecologist or your family doctor and nurse practitioner and get a workup to make sure everything's OK. You know, if you're experiencing extreme depression or depression, that's just getting in your way of your life really significant sleep problems. It's normal to gain five pounds in perimenopause, menopause, our estrogen, the kind of estrogen we're producing most of our lives, shifts to one that has less metabolic activity.

[00:39:55.490] – Dr. Aviva
So we might put on a few pounds, but the symptoms, they may be they may get your attention, but they shouldn't make you miserable. If they're making you miserable, then there are things that you can do about that, whether those are natural therapies or whether they're pharmaceuticals to help you get through that time. And I think, you know, another thing is some women experience a little bit more vaginal dryness and so that can interfere with sexual pleasure or wanting to have sex.

[00:40:23.620] – Dr. Aviva
So if a person is in a partnership, it's really important to be having those conversations and it's really important for partners to be incredibly understanding. You know, I really had to talk with my husband. We've been together for thirty seven years now and I really had to explain to him, look, my self perception is and I didn't have like really significant physical symptoms, but my self perception is really changing. And I need you to understand that this is hard.

[00:40:53.540] – Dr. Aviva
There's some part of me that is mourning and grieving, being young, the way culture defines being young and my kids are grown. I've got grandkids, you know, it's just different. And I need that deeper level of support and understanding. You know, in our culture. I mean, you can age as a man, you can be bald as a man. You can be short and squat as a man. And you can still be you know, I always remember what was Dudley Moore with Bo Derek.

[00:41:25.040] – Dr. Aviva
I'm old enough to remember Dudley Moore was Bo Derek, and he's this five foot tall, you know, average looking guy who's with this, you know, ten, right? That's what she was ten. I think it was Dudley Moore. You know, we see that. But in our culture, women were just treated differently. The standards are different. So as we go through physical changes our skin, changes our hair changes, our facial structure changes, our bodies change, it can be really tough.

[00:41:50.640] – Dr. Aviva
And so having a lot of self compassion and having your partner be really supportive is so critically important for this time. And yes, have celebrations, you know, I mean, do it on Zoom. Do it with your girlfriends, you know, buy yourself that thing that you wanted as you enter menopause, you know, the way you would celebrate your daughter getting her first period or your daughter having her first baby do some special things for yourself.

[00:42:14.680] – Dr. Aviva
It's I think it's really a beautiful thing to do.

[00:42:17.760] – Allan
Dr. Aviva , could you take just a moment and walk us through your six week hormone intelligence plan? Because I really like some of the lifestyle things that you have in there as far as a way to support women's health as you go through and actually many of those things are things that men should be doing, too, but..

[00:42:34.620] – Dr. Aviva
Peopla ask all the time can men do your books. And I'm like, absolutely, you have gonads. We have ovaries.

[00:42:40.350] – Dr. Aviva
And a lot of the environmental factors, the dietary factors, the stress factors, they're affecting all of us and people who have a uterus, who don't identify as who, you know, who are men. So we're in a time with gender fluidity so anyone can really use the book. And I've had men who, with my last book, Adrenal Thyroid Revolution, did the book with their partner, which is great because it's supportive for the woman doing it.

[00:43:04.620] – Dr. Aviva
But men get phenomenal benefits. So, yes, you can. And so the six weeks are based on six, if you will, root causes or things that we can do and look at supportive areas. So the first thing is it starts with what we eat because what we eat is such low hanging fruit and our diet can be one of the most phenomenal things that we do to support our hormones and our overall health. So the diet is really very simple.

[00:43:31.890] – Dr. Aviva
It's based on a Mediterranean style diet, which all evidence shows is the best thing we can do for ourselves in terms of eating. And it's not restrictive. It's based on eating plenty of plant based foods, but also fish very low on red meat. I'm not opposed to eating red meat, but we know that red meat can contribute to inflammation that can contribute to period pain and Demitrius as chronic pelvic pain, et cetera. So it's good quality protein, mostly plant based, but also fish and poultry, lots and lots of vegetables, nuts and seeds, good quality fats, very simple.

[00:44:08.400] – Dr. Aviva
And like five weeks of meal plans that come with the books of the recipes are done for you. And they're really, really wonderful. I mean, I created all of them except for two that I asked permission to use, but they're all from my own kitchen. I love to cook and they're just formulated to be really great for our hormone health. The second part, the second and the third week, are based on our stress response and sleep and circadian rhythm, which are interrelated.

[00:44:35.580] – Dr. Aviva
So we know that stress has a huge impact on our hormone health. It also makes our lives not as fun and wonderful. So there are some really actionable, straightforward tips. And, you know, I know we're all busy human beings. We don't have time for a crazy, complicated plans. So it's really simple things that you can add into your everyday, like spending a little less time on Instagram before you go to bed or checking your email before you go to bed or just adding in five minutes of breathing exercises.

[00:45:03.870] – Dr. Aviva
When you wake up in the morning, it's getting out in nature once in a while. It sounds very simplistic, but it's really simple shifts that I know women can incorporate because I work with women all the time that do actually make a difference. And then with sleep, it's about how we get better sleep and why we need better sleep. There's a chapter on gut health. The relationship between our hormones and our microbiome is phenomenal and fascinating. And it's how you can use your diet, your stress release, your sleep, but also very specific things that we can do for our gut to get our gut working for our hormones.

[00:45:40.470] – Dr. Aviva
And also, 90 percent of women have some gut symptoms, whether it's IBS, constipation, gas and bloating, premenstrual bloating. So it's specific tips to get all those things in line as well. Then there's a chapter on detoxification, not like a juice cleanse or detox, but actual how do we use our diet and supportive supplements and botanicals to make sure that our liver detoxification pathways are working optimally? Because that's where our hormones, after we've used them and the ones that we pick up from the environment that I talked about earlier get broken down and packaged for elimination.

[00:46:19.440] – Dr. Aviva
So we're literally enhancing our bodies are supporting our body's ability to do that. And in each of these chapters, I talk about, well, why are these things not working optimally? What is it about our world that's affecting each of these? And then the last of the six weeks is really novel specifically to my book, which is how to support our ovarian health and our ovarian function. So we're supporting how the ovaries literally work through mitochondrial health and how that can help us have an easier, healthier menopause, easier, better fertility, but also more normal and regular cycles throughout our reproductive years because ovulation happens there.

[00:47:00.720] – Dr. Aviva
And then the book then has a whole separate section, which is advanced specific protocols. So you do the core plan, but then let's say you do have endometriosis or uterine fibroids or you do get urinary tract infections all the time or you do have PMS. There are also very targeted plans that you can add in to the core plan to help you with those specific conditions and symptoms.

[00:47:25.810] – Allan
So, Dr. Aviva, if I define wellness as being the healthiest, fittest and happiest you can be, what are three strategies or tactics to get and stay well?

[00:47:37.540] – Dr. Aviva
Well, I think, one, as women, I think we can start to think that we're not healthy people. If we have fibroids, if we have PMS, there's something wrong with us. So the first thing I think to get healthy and fit is to actually recognize that you are not defined by your symptoms, that you are healthy, your body is doing the best it can. And so really reminding ourselves every day that my health is not defined by this, that I can be a healthy person with my attitudes, with choosing things that make me happy.

[00:48:09.550] – Dr. Aviva
And then I think the next thing is something that a psychologist that came in and taught us when I was in medical school said to me, I've been a psychologist for like 50 years, and it was such simple wisdom. He said, figure out what you love and do more of that, figure out what you don't love and do less of that. And I mean, obviously, we all have to pay our taxes and, you know, we go in for our pap smears every five years.

[00:48:32.500] – Dr. Aviva
None of us loves that. Those are the things that we have to do. But what are the things in our life that are just making us miserable that we can actually take off of our To-Do list? And what are those things that you know, that make you happy that you're always putting on the back burner that you can just do more of? And it can be picking one thing from each category. You know, I really, really don't love X, Y, Z.

[00:48:54.910] – Dr. Aviva
I don't love getting together with those people every week. So I'm just not going to force myself to do that anymore. But what I really love is dancing to loud music, and I hardly ever do that. So I'm going to put it in my calendar that every day for ten minutes I dance to loud music. So, you know, whatever those things are for you. And then the third thing I would say, and it's kind of almost like a take your pick, either add in a little bit more exercise, a little bit more time in nature, making sure that you're getting better sleep.

[00:49:23.950] – Dr. Aviva
You know, there's sort of this smorgasbord of things that are really important for daily basic wellness and just start with one, but then aim to do a few. So if you're not getting seven hours of sleep at night, aim to get those seven hours, if you're not exercising or moving your body, figure out how you love doing that and do it. And it can be a walk. I just bought myself a hula hoop. I bought myself a two pound weighted hula hoop.

[00:49:49.750] – Dr. Aviva
I can I tell you, I'm laughing my way through my exercise. And apparently thirty minutes of hula hooping, which goes by in a minute, if you put on great music, is equivalent to like thirty minutes of salsa dancing or other aerobic, gentle aerobic types of exercise but solid gentle aerobic types of exercise. So I think those are three things. Yeah. Love yourself, do more of what you love, less of what you don't love, and add in some healthy habit that you really make a commitment to good sleep, good exercise, good eating, any of those.

[00:50:24.670] – Allan
And all that. Get this book.

[00:50:29.110] – Dr. Aviva
Yes, that would make me happy and healthy.

[00:50:30.880] – Allan
It will definitely make them happier and healthier because there's a lot in here. Dr. Aviva, if someone wanted to learn more about you, learn more about the book, Hormone Intelligence, where would you like for me to send them?

[00:50:42.220] – Dr. Aviva
So to learn more about me, go to avivaromm.com. Tons of free resources for you. I mean, you can spend hours in there learning things, enjoying things, finding great recipes of delicious foods to make and learn about me. If you want to learn more about the book, go to avivaromm.com forward slash book. That's the easiest way to find out about it. And that's right on my website. So you can still link over to all the good stuff and then also my Instagram, just avivarommmd. I'm on there a lot and put up, you know, I try to always like add a lot of value to my Instagram.

[00:51:14.710] – Dr. Aviva
So it's fun stuff, informative stuff, moving stuff, empowering stuff. Those are the main places to come hang out with me.

[00:51:21.750] – Allan
You can go to 40plusfitnesspodcast.com/490 and I'll be sure to have links there. Dr. Aviva, thank you so much for being a part of 40+ Fitness.

[00:51:31.210] – Dr. Aviva
Thank you so much for having me, Allan. This is a pleasure.

Post Show/Recap

[00:51:40.260] – Allan
Welcome back, Raz.

[00:51:41.640] – Rachel
Hey, Allan, wow, I don't even know where I want to start with your interview with Dr. Aviva, but I do want to highlight and amplify her six tips for dealing with medical care, because as she read off every one of those six items, I was just nodding my head, shaking my head. I think I've experienced every single one of those situations, which is an unfortunate situation.

[00:52:06.450] – Allan
It is. I mean, you know, we grew up kind of in that I would say we're in that gap, the nexgen gap, you and I are. And so for us, we're a trust but verify kind of people. And so we're not as maybe as likely to believe the white coat means the world than maybe the generation before us was. And why not? So, yeah, when a doctor walks in and says, you have to do this, you know, I think particularly when I was younger, I know the answer was absolutely doctor.

[00:52:38.250] – Allan
But then as I got going, I started realizing, OK, he's the guy who I went to medical school and yeah, he's preg ty smart. But I actually have to answer some of these questions myself. You know, I remember going in and I mean, I had no money whatsoever as a kid, young guy going into the doctor. And I had these moles and I went in and I said, OK, you know, these moles on my back.

[00:53:03.060] – Allan
And I said, they keep coming off when I'm playing football and I'm bleeding all over the place. He's like, yeah, I guess I could burn them off, but they might come back when it was five dollars each to burn them off. And I mean, I had hundreds of these. So there's been a whole lot of money. And then he's like. So I said, you really can't tell me what's causing it or what I could do to make it go away.

[00:53:21.660] – Allan
And he said, no, I'm like, OK. And then I walk out and give the nurse fifty seven dollars and I'm like, you know, and I'm fifty seven dollars now doesn't sound like a whole lot. But then that was, that was a week's worth of pay. I mean that was a lot of money when you're making 3.25 an hour giving someone 57 dollars to just tell you I can't help you.

[00:53:42.480] – Rachel

[00:53:44.250] – Rachel
It's disappointing.

[00:53:45.810] – Allan
It is. So but that was actually probably a really valuable lesson to say, OK, you know, I'm going to have to make decisions for myself. I can't rely on the doctor to know everything. And I can't rely on the doctor to tell me what to do. I can ask the doctor questions and then I have to make the right decision for myself. And the right decision was to just let football keep taking them off, which it did.

[00:54:15.390] – Allan
so it's a pain as each one got ripped off my back as I was playing football. But it, they came off and they didn't come back. So that was the good thing. And I didn't have to pay five dollars apiece. I got to play football to do it. But you know, but it was fine. He just he said, you're not in danger. You're not you know, it's sometimes it seemed like it with a white jersey, like I was going to bleed out.

[00:54:38.280] – Allan
But in a general sense, it was just, you know, a little bit here, a little bit there. And it was not that much pain, but it was pain and it was what it was. But it was over, you know, and so they were gone. And so I think, you know, even though that's not relative directly to women's health, it's just one of those things to say the doctor can give you information.

[00:55:00.380] – Allan
and then you have to process that information, and if what the doctors told you doesn't answer all your questions, you have to ask those questions. That's going to be a normal thing for all of us.

[00:55:12.110] – Rachel
That is true. I also like Dr. Aviva's analogy where she mentions when you take your car to the mechanic, you're not a mechanic. You're trusting your mechanic to tell you all the things that might be wrong with your car. And then you make the decisions and what you need to do. And similarly, you know, I didn't go to medical school. My doctor went to medical school and she's got years of experience with patients. And the interesting thing about women's health is that we literally have generational levels of data regarding menopause and perimenopause.

[00:55:45.980] – Rachel
This has happened to every single woman for a really long time. So you would think that there would be a whole ton of data in that you would think that it would be a lot easier to figure out what's going on when it's going on. But it still seems to be a mystery.

[00:56:02.090] – Allan
Well, for one very, very important reason. And this is the key. This is the magic bit. We're talking about hormones.

[00:56:12.020] – Rachel

[00:56:13.280] – Allan
OK, and your hormone profile is different from every other woman that's ever gone through perimenopause. It just is. OK, you're a long distance runner, you eat a certain way, you sleep a certain way, you have stress, you're in a certain part of the country, a certain part of the world. You're exposed to different toxins than other people might be less than some more than others. So your hormonal profile is slightly different than everybody else.

[00:56:46.470] – Allan
And as a result, your experience of all of this will be different than other people. Now, within a range of opportunity. So perimenopause, as it goes, tends to have some similarities. And that's where you kind of start looking at it. And that's why some of the things we got into, you know, like fibroids and those types of things is like, what are the things that if this were happening that a woman should

Consider or be concerned about and so it's not so much comparing yourself against another woman. I don't understand, she went through perimenopause like it didn't even happen. She popped into menopause. Bouncing around. And, you know, she's my running partner and she didn't have any of these problems that I'm having. So what's going on? Well, you're different. Have a conversation if she's available, have the conversation with your mother, because genetically, she's probably the closest individual that you have.

[00:57:45.720] – Allan
If you have older sisters, they're a good source of information for you to have conversations about what their experiences were because, again, they're genetically similar to you. So there's likely to be some overlap in how you are affected. But beyond that, where you really want to spend your time and this is what was in Dr. Aviva's book is comparing yourself to you.

[00:58:09.720] – Rachel

[00:58:10.800] – Allan
You know, if things are changing. So if your flow is a little heavier now or you're experiencing a lot more PMAs or things like that, well, those changes are indications that something inside is changing. Something in your hormone structure is changing. And there are some some remedies and things that you can do that are natural and there are some that you definitely need to be speaking to a doctor about and those that's going to be the information that you process.

[00:58:43.760] – Allan
So you go into a doctor's visit with the right questions.

[00:58:48.860] – Rachel
I think it's been about two years I've been dealing with changes. I'll be turning 50 in July. So that's right around the corner. So for the last couple of years, I've noticed a whole lot of changes. I was on birth control that wasn't working, changed it. It's not working. I've been seeing my doctor different hormonal changes and fluctuations. I also had the ablation procedure pretty recently. So, yeah, it's been helpful to keep a journal of what happens to me every month.

[00:59:24.830] – Rachel
And I write everything down. I write down the days that I'm moody or craving chocolate, all the classic symptoms. I have bad cramping days where I just can't seem to get anything done and which is all strange. And this is why I want to mention this, is that this has been a notable change in my life, which means something's different. And so when I go to a doctor and I say this is not right for me, something is going on right now, then they can help me pinpoint, you know, what blood tests do I need to do?

[01:00:01.400] – Rachel
What hormone tests can we get done? And the more information I can give my doctor, the better she can prescribe a remedy. And that's how it's been going for the last two years. And perimenopause is one of those things. It's not an overnight situation. It's not like you got the kind of colds. You take some antibiotics and you'll be done in a week. This is a very long process, a very long hormonal change.

[01:00:25.370] – Allan
Yeah. I mean, because it can go on eight, ten years. Someone can go through a little quicker, but it can be up to eight to ten years is where I think most of that kind of falls, that your body's just changing its hormone profile. You're getting past your reproductive years and you're moving into the next phase of womanhood. And much like, you know, I've had several women on. But it's somewhat you know, it's just a moment for you to celebrate that you are who you are and, you know, you've had children.

[01:00:57.410] – Allan
And so it's like now, you know, you're you're moving on to a phase where, you know, they've got some college to do. But then I'm assuming that there's probably some grandbabies like the third, mike the third coming out.

[01:01:10.610] – Rachel
Fingers crossed.

[01:01:13.190] – Allan
You know. And so that's just kind of this is a transition in life. But that said, you deserve adequate medical care. And the way you get that is by educating yourself and then not so much depending on Doctor Google, but with the information that you're able to kind of understand.

[01:01:32.830] – Allan
Having an empowered conversation with your doctor.

[01:01:35.740] – Rachel
Yes, yes, that's perfect. I think do your Google research, ask your mom, ask your aunts, go online, see if any of it makes sense to you, and then ask the professional, ask the doctor for added insight. And if you're not happy with your doctor, it's time to change. If you're not getting good answers, it's time to change. There's got to be somebody out there that can help you.

[01:02:02.650] – Allan
Yeah, and I've had doctors that I'd meet with and we'd have some conversations and then I'd be like, oh no, he doesn't get it right, you know, or I don't get him. And therefore, if I don't feel like he understands my situation well enough or is taking it to the right level of seriousness, then I'm like, OK, I have to move on. Yeah. Because I, you know, for most of you know, the last I'd say 10 years or so, 15 years maybe I've been more concerned about well care than sick care.

[01:02:34.420] – Rachel
Well, yeah.

[01:02:35.050] – Allan
When you try to make an appointment with a doctor and they're like, OK, what's the problem. And I'm like, I don't have one. I just want to I want to get these labs. I want to get labs done. I want to sit down, talk to you about them. And they're like, well, OK. But I don't you know, it's like they know they don't have time to sit down and talk to you about your labs.

[01:02:56.860] – Allan
so what they're really going to do is they're going to sit there and say, OK, what's high, what's low? OK, you need to be on a statin. And your blood pressure was a little high this morning. And, you know, so maybe we need to watch that. OK, and how much are you going to bill me for that? and it's more than fifty seven dollars

[01:03:18.280] – Rachel
in this day and age. It is, that's for sure. But the other thing I want to mention too, is, like you just mentioned, cholesterol and and statins is that there is a bell curve like most people have certain levels of iron in their blood or certain cholesterol levels. I mean, we all know what cholesterol means. But just because your numbers are high or low or in or out of that bell curve doesn't mean that they're not normal. I mean, my iron is always low, which means I'm usually fatigued.

[01:03:50.620] – Rachel
It's in the healthy range of iron, but it's always on the low side of the healthy range. So I still will take an iron supplement to fix that because that's what I need. And going back to where all individual, that's just another one of those examples.

[01:04:06.640] – Allan
Yeah. And that's one say you just you know you and then that's kind of your job. Number one, as you're looking out for your own health, is to say, OK, what do I know about myself? What are my tendencies? What are the things that I've seen in the past? And then as those things change, that awareness, I love the fact that you're doing a journal that's that's brilliant because that's going to give you that data to flip back and say, well, you know, I was really stressed out this time last year, you know, because of stuff going on in the world.

[01:04:39.910] – Allan
How does that relate to how I'm doing now? and you start seeing some similarities. You're like, oh, OK. You know, I might my son just went got his first intern job and we moved him there. And it was a tough weekend. And then I'm feeling this way. My energy is low. What was going on a year ago when I felt the same way and it's kind of I call stress and I realized my Iron's low well have I've been taking my iron lately or getting enough for red meat.

[01:05:09.250] – Allan
It's like, no, I haven't. So there we go. OK, maybe that'll help. And so it kind of gives you that that information of who you are and how your body works, because most of the time it's going to follow particular patterns. Menopause is one of those weird things where your body is now changing over. So there is an opportunity for it to be quite different.

[01:05:33.130] – Rachel

[01:05:34.240] – Allan
And this is also important. You know, we talked about this and probably aren't very many men still listening to this show at this point. But this is just as important for you to understand as it is for her, because in the end, if she's going through something, you're going to be in a better position to recognize the change and you're going to be in a better position to remember objectively what she did last time.

[01:05:59.940] – Rachel
Yup, it's helpful to have another set of eyes.

[01:06:02.460] – Allan
If there's not a journal involved, it is really hard particularly when we're dealing with hormonal issues to be objective.

[01:06:12.030] – Rachel
That is so true.

[01:06:13.380] – Allan
I'm not gonna say it's impossible, but I'm just saying, if you're struggling with some things, with PMS, with heavy bleeding, with some other things that are going on as a woman, women can never wrap our minds around that. And I'm not ever going to try. But all I can say is I know that's not a time for my wife to be rational. All I can say is, hey, how about you try this iron supplement and I'm taking us out to Ăšltimo Refugio tonight to have steak, how's that?

[01:06:43.010] – Rachel
That a good idea.

[01:06:48.360] – Allan
You know, and just knowing, OK, what did I just do. I got to start upping her iron. And you know, at least at that point, I'm not being, kind of stepping in and say, well, you know, the last time I mean, that's not I'm not Dr. Allan and I'm not trying to be that person. I'm just trying to be supportive and say, OK, I see a pattern and I know what helped last time.

[01:07:13.380] – Allan
And so I'm going to try to make sure that is at least in play here to see if that does some good.

[01:07:19.890] – Rachel
it's helpful for sure. You know, these are frustrating times. I mean, even for myself, this has been a frustrating couple of years because I know I don't feel good on these certain days. I know that some days I could run for days and some days I just can't barely get out the door. But and it's frustrating. And so that's frustrating for me then it becomes difficult to manage the rest of what I do on a day to day basis and help my family.

[01:07:46.260] – Rachel
So, you know, we could always use a little bit of empathy when we're having those types of bad days.

[01:07:52.680] – Allan
Yeah, that's a good word, empathy.

[01:07:54.990] – Rachel
Empathy. Yeah, that sounds like a great book. I might have to read it myself.

[01:08:02.370] – Allan
You know, that's one of the things I try to make. I make a point of about once a year trying to have a book on women's health in this area. I'm in a particularly menopause, perimenopause. And so this was one of the better ones that I've read on the topic. And she's, you know, she's really walking you through it from the medical perspective. Of course, you know, I've had other authors on that have talked about it from an emotional perspective.

[01:08:27.180] – Allan
This is this is a really good one to get into because she really is an advocate for health care for women and that you're not getting necessarily the health care you deserve all the time. And you and your spouse, partner or anyone, you're going to go to the doctor and talk to the guy who's got to go in with the united front. Yeah. Get you the best health care you can get.

[01:08:49.500] – Rachel
That was a great, great tip for sure.

[01:08:52.060] – Allan
Yeah, right. Well, Rachel, I'll talk to you next week.

[01:08:54.750] – Rachel
Great. Thanks. Take care.

[01:08:56.670] – Allan
You too.


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