Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health Podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Ashlesha Patel, Associate Chair of Obstetrics and Gynecology, about understanding women's health from periods to perimenopause. Thank you so much for being here today, Dr. Patel.

Ashlesha Patel, MD: Thank you, Maggie, for having me. I'm really excited to talk with you today.

Host: So, to begin, can you explain what a woman's reproductive life course is?

Ashlesha Patel, MD: Yeah. Again, I'm an obstetrician gynecologist. So, I've been taking care of women for almost 30 years now. We lead a journey in this lifetime, not only medically, but socially and so forth. And often when we take care of young women, it's from periods to menopause and beyond, but we have a habit of segmentalizing women's health, which can be very problematic.

Host: Why is it helpful to think about reproductive health as something that evolves over time?

Ashlesha Patel, MD: if we think about our life, our reproductive health like a book, you can't have the ending of the book without the beginning of the book or the middle. And so, we have these chapters that build up as our life goes on. And so, as a clinician, we can't just think about the now without understanding what happened before. So, we have to think more in that way, which is a different way that we've often seen women's health.

Host: And in the early stages of this journey, what are the most common menstrual or reproductive issues you see in adolescents?

Ashlesha Patel, MD: If anyone's been through it or knows somebody who has been through it, the menarche, the beginning of periods can be a very challenging time for young women. There are a lot of body changes. There's certainly periods which are a very unusual change, which can also lead to a lot of discomfort and pain, which can disrupt going to school, managing even the clothes you wear, simple things like that. But more importantly, they can affect a young woman's health and their life at that time.

The other thing that we have to think about is mental health and also, other well-being, obesity, nutritional health, and so forth. So, there's a comprehensive facet to this stage of life.

Host: And as women move into their 20s and 30s, their priorities often shift, whether it's contraception, fertility planning, or managing conditions like PCOS, for example. What are the most common reproductive health needs or concerns during this stage?

Ashlesha Patel, MD: Yeah. So, again, as we go into chapter two, let's say, or unit two, now, women are thinking about different things. They might be done with schooling, and they might start thinking about, as you said, sexual health. That introduces contraception, that introduces fertility, relationships. And we can't forget the other things that we mentioned also, well-being, mental health. Those are still there and haven't gone away. Sexually transmitted infections can be challenges, too.

So many women have those issues and things to think about, and then there are other medical conditions which are there, such as PCOS, which is polycystic ovarian syndrome, and that can be changes that affect, again, periods, well-being, the metabolism, and so forth. These are very common, maybe one and two in 10, may see this. But again, we can't forget about the other things that may have started during adolescence and now are manifesting. Again, contraception, very important. Unintended pregnancies are unfortunately very common in the country, as well as infertility, and one in six couples might have trouble conceiving. So, very challenging times.

Host: Wow, one in six, is that kind of a statistic that's been around for awhile or has that gone up? That seems high.

Ashlesha Patel, MD: Yep. No, it's a statistic that's been around for awhile. What is interesting in this phase is that women are across the country and actually across the globe, delaying childbearing to later years. So, there are more challenges with that in terms of other medical problems, hypertension, diabetes, obesity, and so forth.

So, even pregnancy itself, which we think of as the safe time, exciting time, also can be fraught with some challenges. So, again, hypertension, diabetes, even at the time of birth, hemorrhage can be common. One in 10 women might have a hemorrhage, which is bleeding at the time of childbirth. So, even when we think of the happiest times of pregnancy, they also are not so easy. And the postpartum period is equally challenging. For, again, those of you who might have had a baby or might be having a baby, it's a definite adjustment.

Host: Absolutely, it sure is. Perimenopause often catches women off guard. How early do signs typically begin and how can we help normalize and prepare women for this transition? Because you often hear women say, like, "This came out of the blue. I wasn't expecting that."

Ashlesha Patel, MD: Well, and it's a funny thing, because just like the beginning of periods, the end of periods is actually a known. And so, I have many colleagues and friends, because I'm in this age group, they're shocked. I can't sleep well. I'm feeling very irritable. I just don't feel well. I'm gaining weight. My periods are coming very irregularly or heavy. And those are signs of menopause, and that might start in the mid-40s. But the average age of menopause in this country is about 50, 51. But there are a lot of sort of subtle symptoms so that people may not overtly realize it's happening, but it's just you're just not quite on. And you're noticing it at home, you're noticing at work. This was something that, again, in our field, in obstetrics and gynecology and medicine in general in the 2000s, we kind of didn't think too much about menopause, but it is the hottest topic in our arena these days. So, again, I feel fortunate as I made this transition that it's a hot topic, but I know that there are many that are coming that will have a lot more offerings that we won't quietly go through menopause suffering, but actually go through it triumphantly.

Host: Not easy being a woman, is it?

Ashlesha Patel, MD: Well, it's great. I have to tell you, I'm a fan of women, and those that identify as such, but it is not easy, for sure.

Host: Right. But menopause brings a set of physical and emotional symptoms, as you mentioned, that can really impact daily life. Any thoughts on the progress in menopausal care?

Ashlesha Patel, MD: Yes. As I state, you know, it is one of the hot topics in our field, which is great. There is a resurgence and interest. And I think, frankly, women need some support. And the other thing is, there are many things happening at this time, or if you choose children, children are growing, we have aging parents. There are a lot of stresses of that life, as well as libido changes, energy changes, different anxieties on the system.

What I'm happy to inform is that there are solutions. And while I am a physician and might have interest in medical solutions for menopause, there are others as well. So, I think that the whole field is evolving to help women not suffer through it or bear through it, which I think even at the beginning when we have periods in adolescence is just kind of muscle through it and it'll get better. And the mid year is the same thing. I think that whole philosophy of just, you know, fighing through every stage is changing. I think we're looking to supporting women, whether it's at the beginning, in the middle, or as we are advancing in our years.

Host: That's very encouraging. And I think you're absolutely right. The more people talk about it, the more normal it can be, and you don't feel as alone. Across all of these stages, from adolescence, to menopause, how do lifestyle factors like stress, sleep, nutrition, and mental health influence reproductive and hormonal wellness?

Ashlesha Patel, MD: I think we're realizing more and more that these are very important factors. I have to say, as I said, 30 years I've been doing this, I don't think I emphasize nutrition as much or well-being as much, but I think we're all knowing or learning in health that these are really critical, and we have to think of the 360.

So, it's not only our medical health, but the wellness. Now, wellness may be nutritional health, keeping ourselves active, keeping our weight in check. But also, keeping our well-being in check, which, again, in a 15-minute visit with a provider, we don't get to touch on all of these things. So, that means for our listeners to reach out and talk about the things that you're really feeling.

And there are other sources. I think we're looking in different ways of offering medical care so that you can have more than just those 15 minutes to get the care that you need. It's an exciting time, I think, for all of us.

Host: For sure. You know, there's a lot of misinformation around women's reproductive health. What are some of the biggest myths or misunderstandings about women's reproductive health that you wish more people understood?

Ashlesha Patel, MD: Again, I think the theme of just get through it is really very thematically seen for women. We go through the process of, again, early on with periods, just get through it and we'll be okay. It does generally get better, or we learn to live with what we have, whether it's heavy periods. So, bleeding through so much that you have to change your clothes or, again, on the other extreme, the night sweats where you have to—you know, I've heard stories of women say, "Oh, I took off all my clothes, I had to change. My sheets were soaking." so, across the whole way, this idea of just grin and bear it is really this mythology that we have to get over.

The other thing is minimizing symptoms. So, we often dismiss things. I think, you know, cardiac health is so critically important. And often, women are missed, because sometimes their feelings are dismissed, frankly. So, we have to get better as the clinicians to pay closer attention. But also, we minimize because we've been used to different things along the track. So, we don't have to tough out things. We do have to explain if we are feeling symptoms and having problems.

Other things, again, on the medical side, hormones, I have to say and disclose, I'm a big fan. But again, whether you are a fan of hormones, whether you may not be able to have hormones for certain medical conditions, we shouldn't think of a hormones as a whole as enemies to accomplish what we need to do, which is menstrual regulation, decrease bleeding, maybe decrease some of the symptoms that come along with cycling. At the menopause time, also just decreasing some of the symptoms that may arise when women are hitting the perimenopause or menopause space.

So, I think, again, education is power so that you can choose whether you choose hormones, for example, or a different alternative methodology. But education is everything. and there's a lot of methodology right now, actually, a lot of politicizing of women's health, which is unfortunate. But again, hopefully, at Cook County Health, if you see us or any other place, you know, ask what you need.

Host: And finally, Dr. Patel, if you could leave listeners with one message about advocating for their reproductive health at any age, what would it be?

Ashlesha Patel, MD: I would say, you know, it's part of our life story. We shouldn't diminish it. It influences everything about our life: our social life, our economic life, our financial life, so many of our choices. We have to be thoughtful. So, in the beginning, how we manage periods and get through school, how we manage our job life, how our reproductive choices, our partners, we protect ourselves against infection and get vaccinated, pregnancy. It is a beautiful, beautiful thing. But also, there are some dangers, and we have to also acknowledge that. .

And then, as we get to menopause, we should hopefully never look back with regret, but look back with triumph for what we've achieved. But that is, like any story, there's a beginning, there's a middle, and the end. And while it's fun to look at the end and get the conclusion, we go through the whole process to have the richness of our story, our reproductive life story.

Host: Well said. Well, thank you so much for sharing your expertise. This has been so informative and good things to think about.

Ashlesha Patel, MD: Well, thank you for the opportunity. I hope we have more in the future.

Host: Absolutely. We look forward to it. Again, that's Dr. Aslesha Patel. To learn more, please visit cookcountyhealth.org/podcast. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share, and connect with us on social media. Stay tuned for a more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay Well.