Women’s Health—Menopause, Hormones, Depression and How to Advocate for Yourself Through Your Body’s Changes
Episode Notes
This episode is an absolute must-listen! If you're a woman journeying through your 30s, 40s, 50s, and beyond, or if you're parenting a daughter, you don't want to miss this conversation. We dive into women's health, including menopause, perimenopause, hormone shifts, reproductive health, and ways to empower young women and girls. Dr. Leslie Appiah is a nationally-acclaimed OB/GYN who has helped women and girls for decades. Her practical and insightful approach is such a needed voice for all women.
Here's what we cover:
1. The impact of hormones on mental health
2. How to get relief for perimenopause and menopause symptoms
3. When to consider an anti-depressant
4. Why your physician might not have a clue
5. How to find one who will!
6. How to empower your daughters to live free of body shame
Do you have questions about friendship for Dr. Alison or Dr. Appiah? Leave them here.
Resources
- Seek Dr. Leslie's services through the University of Colorado
- Called To Medicine website
- The Menopause Talk with Oprah, Drew Barrymore, and Maria Shriver
- Find a Certified Menopause Provider
- Submit your questions related to women's health here!
- Resources for support
Related Podcast Episode
- Episode 63: Spiritual Direction, the Power of Listening, & How to Attune to Yourself and to Others
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Music by Andy Luiten
Sound editing by Kelly Kramarik
While Dr. Cook is a counselor, the content of this podcast and any of the products provided by Dr. Cook are not specific counseling advice nor are they a substitute for individual counseling. The content and products provided on this podcast are for informational purposes only.
Transcript
Alison: Hey everyone, and welcome back to this week’s episode of The Best of You Podcast, where we are diving into some of these “therapy adjacent” ways of tending to your physical, mental, emotional, and spiritual health. And in today’s episode, we’re going to dive into the physical health side of things, because especially if you’re a woman, you know that your hormonal health, especially during some of these key seasons of life, really has a tremendous impact on your mental, emotional, and even your spiritual health.
I’m so excited in today’s episode to introduce you to my friend and colleague, Dr. Leslie Appiah. She is here to talk to us all about women’s health, including hormones, menopause, perio-menopause, reproductive health, and some of the practical things you can do to make sure you’re trending to your hormonal health especially as it impacts your mental and emotional health. This is a fantastic episode. We get so practical. And, Dr. Appiah has agreed to come back on a future episode of the podcast to dive into our questions. As you're listening, please go to the show notes or to my website dralisoncook.com/podcast and look for The Best of You Question Doc. You can enter your questions into that Doc, and we will address those questions with Dr. Appiah in a future episode of the show.
Dr. Leslie Appiah is a nationally acclaimed Ob/Gyn-Gyn physician who specializes in the reproductive health of girls and women. She is also a Professor and the Division Chief of Academic Specialists in Ob/Gyn at the University of Colorado School of Medicine. She is the founder of Called to Medicine, where she coaches female physicians to create and sustain satisfying careers in academic medicine as well as provides resources to help women advocate for their reproductive health care. We’ll talk a lot more about that in this episode.
She is the author of more than 50 peer-reviewed manuscripts and book chapters and given over 100 national and international lectures and workshops on women’s and children’s reproductive health. She serves as chair of several national and international committees on reproductive health and is the recipient of numerous awards including:
- The 2022 American Medical Association Women Physicians Inspiration Award,
- The 2022 American Medical Women’s Association Exceptional Mentor Award, and
- The 2020 Baylor University Distinguished Alumni Award
She is also a 2022 inductee into the American Gynecological and Obstetrical Society (AGOS) and an alumna of the Hedwig van Ameringen Executive Leadership in Academic Medicine program.
She lives in Denver, CO with her husband and 2 middle-school aged children. I’m so excited to bring you this conversation all about women’s health with Dr. Leslie Appiah.
Alison: I am so delighted to have my friend and colleague on today to talk to us about women's health and the overlap between our medical health and our psychological and emotional and even our spiritual health that so often is divided into these silos where you go see a medical doctor and then you go see a therapist when in fact a lot of these things overlap.
I'm so thrilled you're here, Leslie, to talk to us today about all of these things.
Leslie: Thank you so much for having me, Alison. It's my pleasure. And I'm excited to talk about these things. As you've stated, it has a big impact on women, their mental health, their physical health, and their ability to care for themselves and their families. And so it's super important.
Alison: Yeah. So I want to start just asking you a little bit about your journey. Tell us about yourself. You're our first medical professional on the podcast. Tell us a little bit about how you got interested in medicine and women's health in particular, and what fueled your passion.
Leslie: Absolutely. Well, I'm one of the lucky ones where I was able to really figure out what I wanted to do very early in life. So at age nine, I became interested in pregnancy. My friend got pregnant and I was able to go along her journey with her. And I was just fascinated by the idea of helping a woman to bring this healthy, beautiful baby into the world.
And so I knew at age nine, I wanted to become an OBGYN. And so really just stayed on that course, college, med school, the whole time never deviated for at one moment. I thought I would become a literature professor because I love literature. And so that was a moment in college. But really my heart was with caring for women.
Alison: From age nine.
Leslie: from age nine. I knew at age nine. So I entered college medical school and never really deviated from that.
And in medical school, I had the opportunity to shadow a reproductive endocrinologist. So a physician that specializes in infertility and reproductive tract. And in that experience, I was able to see her perform surgery on an adolescent who was experiencing reproductive health difficulty. And I just fell in love with it.
This young girl, it had impacted her ability to function at school and just her happiness and mental well being and to see the condition corrected. And to see her just so thankful, I knew I wanted to do that. So I decided to pursue a fellowship in pediatric and adolescent gynecology after completing residency in obstetrics and gynecology.
So specialty training in adults and kids and helping them to have their best reproductive health.
Alison: That's amazing. It's so interesting because I was actually just talking to my daughter about this, who's now a young adult, around how thinking about women's reproductive health starts very young. Now. I mean, when I was young, we weren't talking about it, but now they're really talking about it starting much younger.
Is that right?
Leslie: Right. And you know, the age of development is about the same. It hasn't changed much. So the average age of menses or having a menstrual cycle is age 12. And that's only slightly different from, you know, several decades ago. And when you compare it to the pre-industrial age, women started much later.
With better nutrition, we started a little bit earlier. But for the most part, you know, menses is around age 12 and breast development is around age 10. But we are discussing it more because now we know we can help young girls with the difficulties that they have.
Whereas in the past, it was one of those “grin and bear it” type things.
Alison: And when you say difficulties, what do you mean, Leslie?
Leslie: Menstrual cramps, right? And we see endometriosis in adolescence. We see ovarian cysts in adolescence. Women suffered. And so we told girls, this is what it's like to be a woman. And, and we all just kind of suffer, but it's a problem, right?
Because it affects the ability to go to school. Some girls can miss up to five days of school a month if we don't intervene or try to address their difficulties, can't participate in sports, can't spend time with friends, girls become anemic, right? So there's so much that can negatively impact their quality of life that we can now intervene.
Alison: I love what you're saying–for so long it's just been like this is what it means to be a woman.
You suffer. And only recently, you know, is there more and more research, more people like you coming alongside saying, no, we can alleviate some of this suffering. Being a woman doesn't just mean you have to suffer. And I just, I'm so grateful for people like you who have devoted your lives to alleviating some of that suffering.
Leslie: Thank you. No, I completely agree. I think about the annual exam, right? So we start having annual exams, you know, really as adolescents, the well child exam and then in our 20s. And I don't think that, unfortunately, we do a good enough job of preparing women for what to expect as we enter perimenopause. We spent a lot of time discussing contraception and pregnancy, but we don't discuss the hormonal changes that women are going to experience and the fact that they're going to experience this in their thirties.
We discuss perimenopause in our forties, menopause in the fifties, but just as fertility is declining in our thirties, so are our hormones. And so really we need to be discussing this with women very early on. Too often I hear women say, “No one prepared me for this. I don't know what's happening to my body. I'm now having hot flashes, joint pain, I can't sleep at night, I'm crying all the time…” and we should be prepared for that right? This is not a surprise.
Alison: It's so true. I have so many friends who've said to me, “I turned 40 and I kept going to my doctor, like, ‘What is wrong with me?’ and the doctor was like, well, your body is changing, but nobody tells you.”
You kind of get prepared for adolescence, right? Like there's this sense of, I mean, hopefully there's this sense of your body's going to go through changes. You might have growing pains, you know, these things are going to happen. And so when it happens, it's hard, but at least, you’re prepared.
Leslie: Can I add another thought on that? I think even in adolescence, we make that experience aberrant, right? We say, well, you know, teens go through these things and they're going to be terrible. And all of that is normal. Right. They're going through these huge hormonal changes, and we should normalize that, and we should embrace that, and we shouldn't make adolescents feel as though something is wrong with them, and they're just a burden to have around, and you know, oh, if they could just behave.
It's normal, and so if we can normalize that experience, we can then also normalize what women are going to go through in their thirties and forties and prepare them and then how to manage it. Right? It doesn't feel good. It's not great, but we know it's going to happen. So we should prepare women for it.
Alison: I love what you're saying. There's almost a stigma or women feel some shame. I just watched the movie that's out right now–”Are you there God? It's me, Margaret.” Have you seen that?
Leslie: I haven't seen it.
Alison: It's all about, you know, coming of age. And I just, it just took me right back to those feelings as a young girl. There's shame involved and then as an older woman, right, there's shame and all this stigma and I love what you're saying to normalize.
This is just what our bodies do. This is actually amazing that our bodies do these things and just talk about them.
Leslie: Right. And then how can we help women go through these changes, right? So that it does not have a negative impact on their quality of life and they're able to function. I mean, you know, that's the age that many women are able to really take on their careers full force, right?
Because they've been raising children in their thirties and early forties, and then to be encumbered by, you know, sleepless nights and be worried about how you're going to present in the boardroom and the office because you're sweating. It's just not fair that we don't help women be ready for this.
Alison: So let's talk about this because you're, you're exactly nailing it. One of the reasons I wanted to have you on was because there's so much overlap between mental health and our physical health and this whole menopause thing, whenever I see women or talk to women who are in their forties, fifties, I'm hearing now it should be even earlier. And there's any of these symptoms, right? That we're talking about fatigue, irritability, sleeplessness, brain fog, joint pain…
We can be so quick as therapists to go down the road of depression, anxiety, not that that may not be the case. A lot of this is in the context of changing hormones, right? So what should women who are experiencing some of these things that we're talking about, what would you recommend they do to attend to this hormonal side of things?
Leslie: Absolutely. And to your point, you know, there are several times in our lives that we experience these hormonal changes, right? So premenstrual women have that dip in estrogen and they become symptomatic postpartum, right? Wide swings in hormones and then the perimenopause.
So these are times that women are going to be particularly vulnerable to mood disturbances. And, studies show that as women enter the perimenopause, they're 45 to 70% more at risk of experiencing depression than they ever did in their premenopause. So women on average–let's say 25% would experience depressive symptoms in the perimenopause two years before the menopause–we're talking 45 to 70% increased risk of experiencing that.
For women who are feeling sad and very tearful, it is important to first check in with your mental health provider because the first line for treatment is going to be, you know, antidepressants, right? After you've dealt with the behavioral things, right? There are things sometimes in our environment that we can change and we need to address.
But after looking at antidepressant therapy or discussions around it, cognitive behavioral therapy, all of those things that we use to address depression, we know that estrogen replacement improves depressive symptoms for women in the perimenopause. We don't see that same benefit in the menopause. So once women are in their fifties, we don't see that.
And it makes sense because the mood disturbance is as a result of the fluctuation in the hormones. Once the hormone levels fall and they're steady, we aren't going to see such depressive symptoms. It's the fluctuation, the up and the down.
Alison: I want to pause there. This is all very interesting to me because I talk to my friends about this all the time. So what you're saying is the fluctuations that start late thirties, early forties, there's fluctuations in the hormones that lead to the increase in propensity to depression.
Once you cycle through it and you come out the other side, when everything balances out, even though that estrogen is lower, are you saying you kind of hit a new baseline?
So here's my question. Do you hit a new baseline that is just more depressed in general, or does your body sort of catch up and it's kind of like going through puberty, you even out, and then you feel more like yourself.
Leslie: Right, right. It's not that you're going to hit a baseline of depression. It's that you're going to kind of go back to who you were, how you felt before going through that transition. And so again, we see that during those times premenstrually, postpartum, and then in the perimenopause.
And the studies really do show randomized controlled trials have shown that adding estrogen replacement therapy to patients who are on SSRIs, SNRIs, or who don't use that therapy, does improve their symptoms. And then you can reassess as they're going through the menopause, whether or not they need the antidepressant therapy or even the estrogen replacement.
Now, you know, estrogen we use for hot flushes primarily in the perimenopause, but there are many, many benefits to estrogen as we are in the perimenopause.
Alison: Leslie, let's, I want to back up. I could just dive in. Let's make sure all our listeners know, because again, so many of us haven't even scratched the surface of what this all means. Technically, how do you know you're in menopause?
Leslie: Absolutely. So the definition of menopause is 12 months of a cessation of menses. So when women have had no menstrual cycles for 12 months, they are by definition in the menopause. The years preceding that are the perimenopause. When menstrual cycles become irregular. Sometimes they start to shorten, so they become more frequent.
Some patients have heavier menses, or some women have heavier menstrual cycles, some women have lighter menstrual cycles, but they'll ultimately start missing menstrual cycles. And that's the perimenopause. And usually that's between ages 45 to 51. So the average age of menopause is 51 to 52.
Alison: Okay.
Leslie: But again, even before women start to experience the irregular menses, they start to feel some of those vasomotor symptoms, the hot flashes, the night sweats, the mood changes.
And it's interesting, even as an OBGYN, I experienced that in my thirties and I did not know what was going on, right? It never occurred to me that I was experiencing hormonal changes. I changed my mattress. I changed my clothing. I changed all these things.
I thought, what in the world is wrong with me? Like, why is this happening to me?
And then they just stopped after several years and I just sort of ignored it. And now I'm in the menopause. And so it's back. But, so yes, we start to experience those symptoms even before our menstrual cycles become irregular.
Alison: So that whole period, it could be 10 years, it could be eight years, you know, anywhere before you have that full year of cessation of your period, your hormones are going to be fluctuating. And that's that whole period when you're going to be more disposed toward depression, toward irritability, in addition to a lot of those physiological symptoms, which is just good for women to know if you're in that, you know, late thirties, forties, and you're experiencing some of this, a lot of it. That potentially could be a result of these fluctuating hormones.
Again, I love what you're saying, Leslie. Check it out with a mental health provider and also check it out with your, would it be your OBGYN?
Leslie: Yes, it would be OB GYN. There are some internal medicine providers and some primary care providers who specialize in women's health, but it would have to be someone specialized in women's health. Not all primary care providers, not all internists feel comfortable with women's health. And so if a woman were going to rely on that, that would be the recommendation to look for someone with expertise in women's health.
And I will even say not all OBGYNs are well versed in menopause. And I think women know that, right? Because we've been seeing our OBGYNs for our entire lives. And yet we are not prepared for this because not all physicians have that experience. And I will say this.
The Women's Health Initiative that came out 15, 20 years ago did many good things, but one of the downsides was that a lot of women were pulled off of their hormone therapy. But even worse than that, education around menopause and hormone replacement therapy was discontinued in our medical education.
So there is a generation of physicians who don't understand hormone replacement therapy, don't understand the menopause because hormone replacement with therapy is not for everyone, right?
But you need to understand the menopause, you need to understand perimenopause and what women are going through because it's really harmful to dismiss these symptoms for women.
Alison: I love what you're saying. I mean, I love how you said that. Again, just, just for listeners to hear that there's suffering involved in the sense that your body is not functioning right. You don't feel well. And you're, like you said, oftentimes your kids are older, you've been looking forward to maybe having more capacity, more bandwidth.
And then suddenly your body doesn't feel well. And you don't know if it's depression or if it's your body, either way, even if HRT isn't an option for you, there are still other things to try.
Leslie: Yes.
Alison: And I just want to add, Leslie, I mean, my experience with, you know, the medical community is, I've had very few people who know what to do. I've had very few doctors. So that's so interesting what you're saying, that a lot of doctors just haven't even been trained. It's like this whole missing piece in their training to help a woman in her forties who has these vague symptoms to understand what she's going through.
Leslie: Yes, I remember as a resident, a patient would walk in with these symptoms and you would almost go into a catatonic state yourself because you would not be prepared to have this discussion.
And this could be a 45 minute discussion, right? So there's nothing worse than a woman feeling gaslighted for going in and saying she's having these symptoms and someone say, well, yep, it's that age or, you know, go get your thyroid checked.
And yes, we should check all of these things, but for the vast majority of women, it's the perimenopause, it's the menopause and we need to know how to help them. Period.
Alison: Yeah. So just to recap here, you should definitely see a mental health provider, but look for a physician that somehow specifies that they've been trained in women's health too–physicians trained in perimenopause, that they've got some knowledge, or you're probably going to walk away frustrated.
Leslie: Absolutely. And the North American Menopause Society certifies providers in menopause. So one could Google “certified menopause provider” and find one in their area. And that would be my recommendation because those providers are going to give evidence-based care. They're going to discuss the full range of options, right?
Non-hormonal to hormonal, behavioral, dietary, exercise, the entire gamut to make sure that women choose the option that is best for them. And what I find, Alison, is some women just want to understand. It's not every woman who even wants an intervention, right?
Some women just want to understand, “What am I going through? What is this? How long is it going to last? And what kind of things can I do, support wise, to get through this?”
And we honor that. We honor that.
Alison: I love that. You use the word gaslighting. Nobody wants to feel crazy. You know, this is normal, right? There's a name for this. It's going to last.
Now I want to ask you, Leslie, you did mention once you get through the 12 months where you are now full on in menopause, what happens after that?
Do you suddenly just feel fine? Does it take a little while? Are your hormones still, you know, when, when can you anticipate? Because I'm thinking of women who are like, okay, I've got a name for it. This is what I'm going through. You know, at least now I know I've got these options.
And then the question is, when will I feel better? When will I feel more myself? And, and I know it's different for every woman, but give me a sense of what happens to the body after you're officially in menopause.
Leslie: Sure. So unfortunately, Alison, it gets worse before it gets better, to be honest. and part of me, I struggle with the definition of menopause, right? Because it kind of gives the impression that this is a finite period, right? The 12 months you stop having periods, you're in the menopause. That's really when symptoms tend to get a little bit exacerbated and women can experience the hot flashes, night sweats, mood disturbances, brain fog, lack of focus, joint pain for seven to 10 years.
Yes, after you're officially diagnosed with the menopause, you’ll experience that for seven years on average,
Alison: Wow.
Leslie: I have women who are on hormone therapy in their late 60s, early 70s, and, you know, trying to discontinue it, they're very symptomatic. So some women just have those symptoms for a really long time.
We know that there are some ethnic variations, some ethnic groups, Hispanic women, Asian women, African American women tend to sometimes experience menopause differently. Part of that is cultural, how menopause is discussed in the culture, right? For some cultures it is discussed for many, many years and decades.
So people are prepared and they plan to go through it and they're better prepared. And in some cultures where these things are taboo, women may experience more difficulty because they're not as prepared or aware of what to experience.
Alison: Interesting. So as you prepare, when you use that word, I know you've kind of gone through the gamut of, but is that what you mean by where you prepare, you adjust your diet, maybe you adjust your exercise, maybe you even create more margin?
What, what do you mean by prepare? Do you adjust your expectations to some degree so that you're not stressed all the time because you can't figure out what's going on with you?
Leslie: Right. I think that's primarily adjusting expectations, understanding what you're going to experience and that there are options for you. And then what those options might be. I think knowing is a good thing. It decreases part of the anxiety and stress around it. The studies show that the Mediterranean type diet is supportive of menopause in terms of severity of symptoms, the cognitive challenges that women experience, you know, decreasing the amount of alcohol we take in, and being as healthy as we can be.
Alison: Mm hmm.
Leslie: It's going to be particularly helpful during that time. Smoking cessation is going to be helpful during the perimenopause. So those sorts of things are things that women can do to help mitigate some of the symptoms that they experience. I think just a lot of self care and understanding, “I'm not feeling well today, so I'm going to dial back a little bit if I can”, right? Not everybody can, but “I'm going to dial back a little bit on the intensity of what I'm doing”, to try to mitigate the symptoms.
But you know, hot flashes might happen seven, 10, 12 times a day, you know, so you can't always avoid that. But those are some of the things that women can do.
Alison: Yeah, it's a chunk of time. If you think about the perimenopause all the way out the other side, which is what you're saying, it can have a long tail out the other side too, until you really come to baseline. And I know it's different for every woman, but I'm also thinking as I'm listening to you, that you've got all of the different options that you've laid out medically.
And then I can imagine that getting mental health support, maybe even an antidepressant, could also be part of your treatment. Even if the bulk of the symptoms are a result of the hormone fluctuations, there's no shame in that, and it certainly could be helpful, even if you're someone who hasn't gone that route before, that might be a route that could help.
I could imagine that it could be a way to just care for yourself. Just give yourself a little extra help to deal with some of the irritability and that kind of thing, especially if you're still parenting or you're working full time or you've got serious demands. That could be a way to get yourself some relief.
Leslie: Absolutely. Absolutely. Many women are just going to need an antidepressant. We could do cognitive behavioral therapy, but some of us are going to need an antidepressant. Even women who have never experienced depression ever in their lives before, have an increased chance to experience it.
We know that having had depression and anxiety before, you're going to be at an increased rate of experiencing it again. I think that the study for women's health across the nation showed a two to four fold increased risk of depression. And that four fold part is for women who have had depression in the past and women who have experienced adverse life events. And what we are seeing is that that plays a big role in the mood disturbances around the menopause, a history of adverse life events,
Alison: Are you talking about trauma essentially?
Leslie: Trauma, exactly trauma, yes, that is going to increase it.
And so those women will need antidepressant therapy. And I think what women sometimes misunderstand about it is that it doesn't have to be forever, right? There are adjustment type disorders that we can use antidepressants for 6 months, 12 months, a year, 2 years. And then wean women off and they do fine, right?
This is a period of time where we're experiencing an adjustment to a new phase. And it is okay to use these therapies. Many times they're just really low dose, uh, therapies that women need, um, around this time.
Alison: I just love what you're saying because, again, there's just no stigma and I think about a lot of conversations right now are happening in the mental health field around trauma and around healing, CBT, some of these other modalities, IFS, EMDR, and a lot of it's amazing and a lot of it gets at let's heal the the childhood memories, let's heal the wounds and we don't want to just necessarily treat the symptoms. We want to get to the root.
But when it comes to something like what we're describing–perimenopause, menopause–where there's this huge hormonal change, you could CBT yourself all you want and you're not going to fix the fact that– correct me if I'm wrong–that your serotonin and your dopamine levels are changing and that's just a physiological thing and an SSRI can provide some relief. We have to function.
Leslie: Right. And CBT, you know, and talk therapy, and those other therapies, they're going to take a while to work. If you're getting down to those adverse life events, it's going to take some uncovering of layers. And women have to go to work tomorrow, right?
Not that antidepressants work immediately. They also take time, but people have to function sooner than later. And so it's going to be a combination of those things.
You know, one of the things, to your point, I think networks are really, really important for women. I think it's important for adolescent girls, right? To have these positive support groups, systems in place that they can talk through things and women who are in the perimenopause and menopause are going to need the same thing, right? We're going to need that because it takes a stigma away.
Alison: So good. It's so true. You've got to find your person or your people with whom to go through it together. Don't go through it alone.
Leslie: Right. And that and that's for all kinds of mental health things and just life in general. I think about how to build resilience and how to have an overall sense of wellbeing. I think those networks are important in teaching girls how to find healthy networks as adolescents.
That's part of what we do as a pediatric and adolescent gynecology provider. I talk to all of my girls, all of my patients about their friends and their peer groups, because all of that plays a role in their mental health. All of that helps them to manage these fluctuations in their hormones. Who are the people that you spend time with and how are they supporting you, right?
And I think that's really important for women. And thankfully we're talking about this more, you know, Oprah has her series out. And so this is what women need to have these conversations and these networks and these dialogues to help us get through this.
Alison: I was so glad when I saw her put it out in the public conversation in a destigmatizing way. I want to talk a little bit about–we kind of did this in reverse order–I also want to touch on, while we have a little bit of time left, how you also help women advocate for their reproductive health, starting with young girls.
I'm curious, what would you say to our listeners? How would you want them to be promoting reproductive health in their daughters?
Leslie: Right. Yes, absolutely. So I think first, we as adults are going to have to become educated in what is fact and what's fiction, right? There are a lot of myths around all sorts of reproductive health issues around fertility, abortion, menopausal health–there's just a lot of myths.
And I think women, we need to educate ourselves about these things so that we can have honest, open dialogue with our girls, because our girls are going to get the information from somebody, right?
And we want that information to come from trusted sources. And so part of teaching girls to advocate for themselves is to help them understand what is factual about their health. And that is why we encourage parents to bring their young girls to see a gynecologist. It's between the ages of 12 to 13. And that freaks some people out because they think, “Oh my gosh, I'm not going to bring my daughter to a gynecologist at that age. I don't want her to have a pelvic exam and we're not doing that.”
But we are having a conversation about what is normal and what is abnormal in your development–breast development, discharge, pubic hair, body odor, what emotions you might feel as an adolescent. We have discussions that are age appropriate.
At age 12, we're going to talk about your body changing. As they become older, we'll talk about the hormones and the emotions that they're feeling and how to manage those emotions. But I think the more the girls can have these conversations with physicians who know the truth, the better they can be prepared to advocate for themselves as they get older.
And part of what we do is we talk about advocacy, right? When a girl comes in, we make sure that the appointment is very centered on her. What do you feel comfortable with? What do you feel comfortable not talking about? So we begin to empower them in that visit. So that when they walk outside of our office, they can be empowered in their relationships with other people.
Alison: That's amazing. I love what you're saying. So as a parent, you can rely on (and I would assume) these gynecologists who've been certified in a specific way. It's like a parent has a wingman, right?
These are hard conversations and there you've got a doctor, a trained physician who can help your daughter normalize and understand what's happening with her body. I love that, which equips her to not feel shame about it, to not feel stigma about it, to have someone to talk to about it, to be more likely to talk to her mom about it, or her dad about it, or her friends about it in a healthy way.
Leslie: That's absolutely right. And you know, I think many parents also think that we're going to talk about sex and how to have sex, but that's not what we're here for, right? That is a parent's role to have those discussions. We will probe as appropriate and provide appropriate information because we want girls to be safe.
But that is not the primary focus of that visit, right? The primary focus of these visits is to help girls understand their changing bodies–what's normal, abnormal and how to advocate for themselves. And we start that by giving them power and autonomy in that visit.
Alison: That's amazing.
Leslie: Right. And so women start having those conversations with their children and then women also need to begin to advocate for themselves.
I think, I mean, we know women are intimidated by physicians. Even as adults, women go into the doctor's office and they present their complaints, and if they're not heard, they sort of leave it at that, right? Because they don't want to push back against their physician or alienate their physician.
But really then you should just find another physician, right? If the physician that you see is not hearing you, then you need to find another physician, because you need to feel totally empowered. It has to be with your reproductive health provider. And so I just encourage women to do their research, interview different physicians and to see who they can truly partner with in their care.
And so that's my goal in terms of helping women to advocate for themselves. What is the knowledge that you should have? Right? What is fact? And then what are your options for care? And then hopefully women can take that with them to their physicians and find someone who really wants to partner with them in their journey in their reproductive health journey.
Alison: Gosh, that's such a great approach. And it's so interesting listening to you, because it's the same thing I say to people about therapy. I always say to people, you should interview a therapist–you should interview a couple. And so many people have this idea of, “I go to my medical doctor and they're the expert and I just have to take, you know”, as opposed to this idea of partnership.
And I would say the same thing to people about therapists, but it's so fascinating to hear you say that. Similarly, about a gynecologist or an internal medicine doctor that go to a couple, see where you feel comfortable, see where you feel like someone's inviting you, you know, where you're going to partner together around your health.
Especially as women, when it comes to your reproductive health, you need to have some agency in that.
Leslie: That's right. That's right. And, you know, it's intimidating because there's all these co-pays and you have to pay a copay for this doctor and then will insurance cover that doctor?
Women can really start online looking at the physician bios. What do they say about how they view health care? Are they there just to do things correctly and pick the right diagnosis, or are they there to really support you through your journey and do shared decision making? And the biggest honor for me is when a patient comes to me and says, I researched you. I researched everything about you online and I decided that I wanted you to be my physician.
And unfortunately, some women wait six, eight months, a year even to see me. They refuse to see anyone else because they've decided that they want to see me based on what they've read and the reviews. And I take that seriously, right? So when I see that patient, that patient has set the bar, right? They have told me what they expect and I am going to live up to that.
And so I partner with them and help them to make the best decisions by giving them the evidence and then seeing what's comfortable for them. That's what we should do.
Alison: I love that, Leslie. I want to have you back on at some point, if you're open for it, to take some of our listener questions for you, because this is just such an important part of our holistic health, our mental, emotional, physical, and spiritual health is especially as women, and I just so appreciate all that you do, all that you pour out for so many people.
I want to ask you this because I ask all my guests and I'm curious, what do you wish your younger self knew? I would imagine your younger self would have been in medical school studying a lot of this stuff. What do you wish you knew about your hormonal and medical health as a woman, when you were in your twenties that you know now?
Leslie: Yeah. You know, that's a great question. I think that fortunately I was an athlete, and I'll start there because I think physical health is really, really important to an adolescent girl's mental health. And it's important to our health as we get older, partly because we learn how to engage with others when we're doing competitive sports and those sorts of things, and our bodies are the best that they can be.
So thankfully I was an athlete. And so I felt very confident in that part of who I was in terms of physical wellness. I would say that networking and identifying people who were the best people for me is something that I didn't know how to do and I didn't know how to do when I was younger in my twenties. I developed that a little bit better as I entered college and formed a really great network of women in college, but I would say, and this is not medically related, but I would say figuring out what you're good at and just doing that.
Like don't try to be someone you aren't. Don't try to strive for other things because people do them. Really identifying what I am good at, and doing that. I think that builds your self-esteem and that helps you to make better decisions in your relationships, and it helps you, I think, to advocate for yourself because your esteem is developed.
That's what I would say to my younger self. Health-wise, I would say there were no concerns there, but I would say in terms of developing that confidence, self-esteem, I think doing the things that I was best at is the advice I would give my younger self.
Alison: I love that you've, well, you've certainly found a niche.
Leslie: I love what I do. I feel fortunate to be able to do it. I love hearing women's stories and, and really just being present for those visits. And so I wouldn't be doing anything else. I love this.
Alison: I love it. How can our listeners find you? I know you primarily work with other female physicians, but how can folks who are listening find you and learn more about what your services are?
Leslie: Absolutely. So as you know, I am the division chief of General OB GYN at the University of Colorado. And so I am fortunate enough to be able to provide consultative services under that role as a faculty member. Individuals can seek services from me through the University of Colorado.
And then you spoke about the coaching. So my company, Called to Medicine, allows me to coach and support young female physicians to continue to build their career in academic medicine, cuz I think it's so important that women remain in medicine and that we remain in academic medicine so we can train future leaders so that we can make sure that women are involved in research and in research studies and push the initiative forward for women's health research.
One of the things we didn't get to talk about was kind of where the research is going with perimenopause and menopause, but we need more research and we're going to need women and women from diverse backgrounds, geographically, ethnically, socioeconomic status wise, to be able to push this research forward.
And so that is partly achieved through Called to Medicine. And then the last part of that, as you stated, was to help women to advocate for themselves and, and would love to just share knowledge and education so women feel empowered.
Alison: Well, we will link to your company website in the show notes. You're amazing. Leslie, I've just loved getting to know you as a person and I love getting to know more about your professional passion and all that you're doing for women and girls and just so grateful for you and other female physicians.
If you're listening and you're in the field or you have friends who are in the field or you have daughters who are in the field, please send them to Leslie's website, Called to Medicine. We need you. There's just been, for too long, unnecessary suffering for women, so thank you. Thank you so much for what you do. And thanks for being with us today.
Leslie: Thank you, Alison. Thank you for having me on. And I'm so thankful to have been able to get to know you over the last few years and that you're doing this podcast and really just shining a light on all of the things that women and humans experience. And so I appreciate you. And I would love to come back and answer questions from your audience.
Alison: I'm thinking we need to do that. That would be really cool. Thank you. All right. So everybody check out The Best of You Question form if you've got your questions for Leslie and we'll plan another Q and A in the future.