Amanda Wilde (Host): One On One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health.

I'm Amanda Wilde. And my guest is Dr. Pallavi Khanna, an OB-GYN physician at Regional One Health. Dr. Khanna is also a Certified Menopause Society Practitioner, which means she has specialized expertise in caring for women during menopause. Thanks for joining me today, Dr. Khanna.

Dr Pallavi Khanna: Hi.

Host: So, well, let's start there. How did you become certified for caring for menopausal women, and why is that helpful to improving a woman's health as she ages?

Dr Pallavi Khanna: Thank you for having me today again, Amanda. So as an OB-GYN physician, every obstetrics and gynecology physician has some level of expertise to be able to take care of women in menopause and beyond. However, due to the practice of Obstetrics and Gynecology, we often forget or we often kind of sideline the special collaborative care that these women need in their menopause and postmenopausal time. So, I recognized that in my patients and went to get a certification in menopause-focused care through the Menopause Society in the U.S., which requires a specific exam, preparation for it, and keeping up with the credentialing. So, that's where I am.

Host: You mentioned special collaborative care for women in menopause. So, is this care helpful for all women regardless of symptoms?

Dr Pallavi Khanna: It may and may not be, depending on what that woman is going through. So, say a woman has some risk factors in her health history, then they may require collaborative care. And a lot of our patients that we take care of in our community do.

Host: Now, how does a woman know she started menopause?

Dr Pallavi Khanna: So, menopause is a clinical diagnosis for a lot of women who still have their uterus, meaning they've not had a hysterectomy. So, it is a retrospective diagnosis. You look back into your menstrual history and then you've stopped having cycles for one year, around the average age of menopause, which is 51 to 52 in the U.S. That's when you can diagnose menopause.

Host: And how does a woman know she started?

Dr Pallavi Khanna: So, usually, the symptoms of menopause may start much before the actual menopause in and of itself. This is called the menopause transition and it varies from women to women depending on their health history, genetics, and factors we don't know. But some women really start having the most bothersome symptoms like hot flashes and vaginal dryness and mood changes much before the actual menopause sets in.

Host: What are the most common menopausal symptoms you hear about, and how can you help with your specialized expertise?

Dr Pallavi Khanna: So, I see women for a lot of problems. The ones that we know of, which are menopause-related symptoms are hot flashes or vasomotor symptoms and night sweats. Also, women may experience vaginal dryness, painful sex, recurrent urinary infections, mood changes, sleep issues. I mean there is no one universal symptom that defines menopause and it presents in various ways and forms.

Host: Menopausal women, as you mentioned, also can face higher risk for serious conditions like heart disease or breast cancer, osteoporosis. What are some of the ways you can address that risk? As

Dr Pallavi Khanna: So being an OB-GYN, and being a primary care as well as a specialty care for women's health, I believe in prevention. So, it starts all the way from figuring out what risk factors are there in women's history; what gives us an insight into whether their cardiovascular health is at risk, maybe because they had a problematic pregnancy, a complicated one, maybe it's their family history. So, recognizing those risk factors early and intervening early can help mitigate these risks. So for instance, if somebody already has borderline high blood pressure and had preeclampsia in pregnancy, we know this patient may have more cardiovascular risks later in life. So if this patient starts having symptoms early in their menopause transition, this may be a patient who may benefit from treatment.

Host: As a woman does approach menopause or maybe she's in perimenopause, or fully in menopause, at what point should she start seeing you for specialized care?

Dr Pallavi Khanna: So, every woman should be seeing their gynecologist at least once a year for annual exams. And this is besides seeing their primary care for their wellness visits. So sometime around age 40 and over, that's when a woman can start expecting to see menopause transition-related symptoms. When they do become bothersome and notice that this is kind of interfering with their life, whether it would be just going out with friends or staying asleep at night, definitely this should be brought up to the gynecologist. Otherwise, the gynecologist or the menopause specialist would be asking these questions when they see these patients on an annual basis.

Host: Dr. Khanna, tell me a little bit about your approach in caring for patients, not just menopausal women, but all women.

Dr Pallavi Khanna: So, I do believe in taking care of women as if they would be my sister, my mother, my friend. And would I want them to go through this? Is this something that they need to suffer through or need to take care of? And with my expertise and my training, I always feel that I need to listen to my patients and hear what they're saying. They are the best advocates for their health. And if my patient is experiencing something, this is not something that I need to brush aside. So, that's one thing I have internalized and taken care of as I take care of my patients.

And the other thing is, obviously, there are so many people out there trying to help women, but not everybody's taking care of them in the way evidence-based medicine and science is supposed to, so I'm a big proponent of evidence-based care. And I always incorporate best practices which are backed up by research and thorough scientific inquiry rather than just putting it out there.

Host: Lastly, you sort of touched on this, but how can developing a relationship with an OB-GYN like yourself help women improve health throughout their lives, not just during menopause?

Dr Pallavi Khanna: Being a women's health specialist, we believe as OB-GYNs, and I'm also, of course, talking, this is my opinion, that we have a special role to play in women's health. Taking care of women right from the moment they start their cycles through their adolescence and then through their college years and reproductive years and pregnancy and beyond, it gives us a perspective to women's health the way that a primary care who's in medicine may or may not be aware of. So, we take certain histories related to pregnancy. We take care of patients through their postpartum period and there are certain risk factors that come through that. So from a women's health perspective and also patients sometimes find it more comfortable to talk to their gynecologist about issues, especially related to sexual health and libido and mood disorders sometimes. So, I feel that a collaborative care with a primary care internal medicine specialist or whoever it may be for our patients would be the way forward.

Host: So, it helps as a patient to have this consistency through their lives, but it also helps the doctor know our specific situation, our personality, and our own physicality, so that when menopause happens you can address it more specifically.

Dr Pallavi Khanna: That's right.

Host: Well, I like to say menopause happens, it's a natural process, but it can be challenging. So, this is great to know about. This specialized menopausal care can help us embrace those changes. Dr. Khanna, thank you so much for this enlightening conversation.

Dr Pallavi Khanna: Thank you.

Host: That was OB-GYN physician and certified menopause society practitioner, Dr. Pallavi Khanna. You can learn more about OB-GYN and menopause care at Regional One Health at www.regionalonehealth.org/womensservices. For an appointment with Dr. Khanna at our East Campus, call 901-515-3100. Thanks for making One On One with Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow..