Transcription:
Woman to Woman - Your Life Should Not Stop When Your Period Stops! Management of Peri Menopause & Menopause

Maggie McKay (Host): Being a woman is not for the faint of heart. There are a lot of stages and during them, many women say, I wish I'd known that before.

Joining us is Dr. Usha Mantha, a Board Certified Family Physician and Diplomat in Obesity Medicine to tell us about her vision; aging is not optional, but aging beautifully is. This is Top Docs podcast. I'm Maggie McKay. Thank you so much for being here, Dr. Mantha, will you please introduce yourself?

Usha Mantha, MD, FAAFP, MRCOG (Guest): Thank you so much,

Guest: Maggie.

Usha Mantha, MD, FAAFP, MRCOG (Guest): Yes. I'm Dr. Usha Mantha MD, Board Certified Family Physician, Diplomat in Obesity Medicine and with my specialty training in OBGYN in England, I'm very well situated here to provide women's healthcare with compassion, courtesy and comprehensive medical care. And also I'm the owner and CEO of Verve Medical Spa. It's a beautiful medical spa here in the foothills of Mount Baldy in Upland, California.

Host: Mount Baldy is beautiful. So, Dr. Mantha, your background as an OBGYN trained physician practicing primary care. What can you share with us, especially from a woman to woman perspective?

Guest: So Maggie, I love women's health and I'm very passionate about it. So I could speak on so many topics, but I chose to speak today about menopause. And the reason for that is, I myself, in menopause and believe it or not, one third of our life, we will be spending in menopause. So if a woman's life span is about 85 years of age, then 30 years out of those we will be spending in menopause.

So as, as big as a topic it is. But I would love to talk today about menopause because as you said, aging is not optional, but aging gracefully and beautifully is. So that's going to be my topic today for speaking with you.

Host: What do you mean when you say your life starts where your menstrual period ends?

Guest: So Perfect. Yes. So like I said, when your periods stop, there are so many life changes that happens that I believe that the life actually do start does start when your period ends. So I call it active management of menopause. And anytime we call anything like active management, there are three parts to it.

First, we need to identify why does it happen. So I'm going to briefly talk to my audience about what is the physiology of menopause, and secondly, we should identify risk factors of who will be suffering from menopause a little bit more than others. And third, of course, is to modify or treat menopause.

So I call it active management of menopause, and so I'm going to go over those today.

Host: So there are many changes, as we mentioned earlier, leading up to menopause and beyond some small, some large. So share with us some of those. I know a lot of women just accept menopause, but there are actions that can be done to manage it, as you say. What are they?

Guest: Absolutely. So number one, like you said, I'm just briefly going to go over what does happen during menopause or the time leading up to menopause. So first of all, something very interesting historical is a female baby in their mother's womb, around 28 year, 28 weeks of gestation starts developing the ovaries. From there on every month, month after month, the ovaries follicles are formed and ovaries are maturing until when we hit the menarche and then throughout the childbearing age the ovaries will alternate between right and left and keep ovulating until the premenopause hits and the ovarian follicles are exhausted. So literally stop producing the youth hormone, which is estrogen. So that is the basic what physiology is going on. So you can imagine from 28 weeks of gestation until 45 years of age or 48 years of age, these ovaries have overworked themselves.

So at that point, the transition happens and the ovaries stops producing what we call as estrogen or estrodial. What does happen is the adrenal glands take over, which we have on top of the kidney, small little glands, and they produce steroids that convert into something less powerful than estrodiol into the peripheral fat of the women.

So what we have is estron, which is a little weaker estrodial in women during menopause. So that's the basic physiology. Now, like you asked, what happens to the body. That is very significant. What happens to the body is because estrodiol is the hormone that keeps all connective tissues intact, whether it's our hair, our skin, fat volume, anything we name it, it has effect on it.

So let's see what happens during menopause. Skin changes, nail changes, hair changes, belly fat increases and the fat volume from face goes down, which is a reality, it really does. So you do gain like about two to four pounds during menopause, and it's such a reality happening. But the most important part it is, is that it also affects brain cells.

It affects your moods, it affects your sleep. And the two major symptoms, the vasomotor, you know, symptoms of hot flashes. Every woman has it almost 100% of the time. How do we manage them is a significantly different thing. But every one of us will suffer from hot flashes. So the vasomotor symptoms are very, very, exhausting.

They can happen daytime, they can happen in a boardroom, they can happen at night. So that those are significant and sometimes it leads to depression because we don't understand them and we are so disabled by them. The second important one is, of course, the genitourinary changes. All of the genitourinary tract is made of skin.

So as I mentioned, as the estradiol goes down, the skin changes absolutely happens. Vaginal dryness, vulvar atrophy, bleeding skin, recurrent urinary tract infections, and stress incontinence. There are so many things that changes during menopause or early menopause. The time it starts about 45 to 55 years of age.

So these are pretty significant. And of course another very significant is your bone loss. It's absolutely a disease of menopause. It starts around 45 and continues up to 85. And all of us who have known someone in menopause, Maggie, you and I, every single person will know that you have known somebody who fell, who broke their bone and then they ended up either in hospital, nursing home, or even had even worse outcomes. So these are really significant changes happening during menopause. And so I think the, when I say about active management, I want us to recognize these and it's just quickly, some other risk factors that makes menopause symptoms worse is your being overweight and obese during menopause, smoking, alcohol and some cultures. Some cultures age better than other cultures, and it is a familial thing. If mother had more symptoms, chances our, the daughters will suffer from it too.

Host: Wow, that's a lot. No wonder no one tells you before it happens. You know how we were saying, people said, I wish I'd known before it happened. In this case, maybe they don't want to know. I'm just kidding.

Guest: Absolutely. I agree.

Host: Knowledge is power, but that's a lot. I mean, it sounds so dismal. So, Dr. Mantha, please tell us about the treatment. There's non-medical and medical, and tell us how safe and available they are.

Guest: Absolutely Maggie. So one thing I want to bring to our audience today is that there is so much help available. You have to ask, you have to go to your primary care doctor. You have to ask for help. So let us talk about what are the things that we can actually change. The modifiable factors, right? So number one, of course I am also an obesity medicine specialist and weight management, and I see mostly women. I really, really encourage you to please optimize your weight during perimenopause and menopause. You don't have to be become skinny. You don't. You will be surprised how many women will say, can I become as I was like when I was 20 years old?

No, you should not. You must not lose weight that much because we need some amount of peripheral fat for these estrogens to be effective. So being a little chubby during menopause is perfectly fine, but if you have overweight, you have extra weight to shed, you must start doing your weight management, number one.

Number two, alcohol in moderation is good, but excessive alcohol will affect your aging and menopause. Number three is smoking. Smoking has to be decreased and stopped almost. Number four is exercise. I cannot emphasize enough. Any little exercise is absolutely better than none because we do know that non-exercise activities also burn calories.

So please stay active. If you are exercising formally 30 minutes a day, wonderful. If you are not, stay active. So those are the just modifiable risk factors. So the next one is of course hormones or hormone light treatments. So I like to just mention that it's okay to try over the counter stuff like your black cohosh and your green tea and evening primrose oil. So these are some of the things that you must take and it's perfectly fine to take, however, the hormones. So the latest situation about hormone therapy is that about 15 years ago, Maggie, I'm not sure whether you remember, we went into a big frenzy about hormones increasing cardiovascular risk factors, strokes and death and dying.

So we had, we pulled back and said, we will not give any hormones. However, the good news is we have done many studies after that and now, the statement about hormones in menopause is that if we want to treat our women, we should actively treat them before 60 years of age, especially for vasomotor symptoms, hot flushes and all the changes, genitourinary syndromes.

Secondly, if we are going to treat after 60 years of age, then we are able to do, you know, other treatments, but we always have to balance the risk to benefit factors. And the hormones are available, whether it's patches, by mouth, a spray, you put the creams on, lotions, potions, rings, pessaries, pellets.

They're like a wide variety of hormones available. However, there are going to be a certain amount of women who cannot and should not use hormones. So let's talk about them. Because for example, breast cancer survivors, for example, women who have had already had heart disease, already had stroke, we are not available there to give them hormone replacements.

No kind of estrogens, progesterone. We should not expose them to them. So those are the women, that do, they will need alternative therapies and I especially want to talk about couple of newer technologies Maggie, if I may. Number one is very popular right now and it's called Mona Lisa Touch, it's a fancy name and it's actually a vaginal procedure.

And I just want to touch base what the origin of this procedure is. Lasers traditionally have been used to cause a very calculated injury to an organ that can reproduce in a healthy way. So we brought that technology to vaginal lining because we do need the vaginal dryness is number one cause of all kind of morbidity during menopause. Hits as early as 55, 60 years of age to the extent that it can interfere with your intimacy and sexual intercourse leading to depression. So here is a procedure which is called a Mona Lisa Touch. It's a CO2 laser, so it's quite invasive laser. But the technology, I must say, is one of the safest.

I use it and I have used many other lasers. But this is a safe technology and it's a quick office procedure. What it does is it causes a very refined injury to the vaginal mucosa, which regenerates, and it becomes healthier, more moist. So, and because the urinary tract, the bladder is right there just beneath the vaginal area, it also helps the bladder health.

So, let's see, it's a office procedure. Very safe in women or in providers who have done many of these. And, it's a session of three times. It's done four every four weeks. And the indications will be if you're suffering from vaginal dryness, painful intimacy, recurrent urinary tract infections, some amount of stress incontinence.

And if you are also just having more of and in fact actually's good treatment for some of the vulvar atrophic changes because we do see a significant atrophic changes. I know women just say, oh, there's nothing we can do about it. We are not using there. So we don't mind. But I say to them, there's so many body parts we don't use, but we do take care of them.

So my theory is, it's not because whether we use it or not, it's part of your body. So love it. Treat it well. Because look at men. I mean, men do it all the time. Who sees them, right? But they love themselves, so women have to love, I know, I didn't mean to say that, but what I'm saying is we have to love ourselves.

We have to say, okay, I'm having these changes. So let me treat this. So, actually Mona Lisa is a vaginal procedure. Laser is very good for vulvar changes if you have atrophy, if you have bleeding skin out there, if you have dryness. So all these things we can treat them with Mona Lisa Touch, which is a very good vaginal laser.

It's actually one of my favorite procedures to do. I feel women do get to see results after second and third one, and they really are so thankful and grateful. So that's one procedure. The second procedure, which is very innovative, we didn't hear about these things, is called PRP. Basically it is a plasma, a platelet rich plasma, which is your autologus or your own growth factors.

Maggie, you know how children grow into adults? They just grow because we give them growth factors. We drink, we eat, we are creating more growth factors. So we extract this growth factor. We, draw your blood, we spin it in the spinner, and we bring this liquid, which is loaded with your own growth factor.

So we bring that fluid. Then we can use it on your vulva, your vagina area and it regenerates the skin. So, latest technology is that we are actually adding some fillers to create a look better looking vulvas and just bring the women's confidence back. So remember, all these things are also part of management of menopause because if we let our body go, our confidence slowly goes down.

So these procedures are helping to bring our us back, bring that confidence back because women have to do so much more in their third trimester, I would say in of life. We have to be out there, be grandmas, and be sitting in the boat, all the boats. And we have such an active lifestyle, we can't let our body let us down.

So I love the PRP regenerative procedure. We do this and you can do one or two sessions fairly painless. We do numb you for that area. And it also increases your, if you have orgasmic disorder, it's a good indication to do this procedure. Again, it should be done with your medical provider who knows what they're doing, and understand you as a person. So Maggie, so those are the things that I would love to talk about so.

Host: Dr. Mantha, that's a lot of good information and you bring up a good point that you know, oftentimes women seem to put themselves last. You put everybody else and everything first, and you don't take care of all parts of your body, which is a good reminder for us. So tell us why women should see you and how they can connect with your office.

Guest: Yes, Maggie. Like I said, with my background of training as an OBGYN and being so passionate about women's health, and now I'm a family physician, but I bring all the specialty training into a primary care setting so you can come to my office, feel safe, not judged at all, and very privately. And the ways you can connect with us, we can, you can visit our website, which is actually called verve v-e-r-v-e med spa.com. You can connect with us on the Facebook and Instagram at Verve med spa handle. You can send us an email at info at Verve med spa.com and you can also call my office, which is number is 909-377-2939.

Host: Thank you so much for this invaluable information. We appreciate you making the time to share it cause we know you are busy.

Guest: Thank you Maggie.

Host: Again, that's Dr. Usha Mantha. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Top Docs Podcast. I'm Maggie McKay. Thank you for listening.