Transcription:
Menopause

Amanda Wilde (Host): Menopause is normal, but it is a transition filled with physical changes and emotional challenges. We'll talk about what to expect and how to best manage menopause with Dr. Deepali Kashyap, functional gynecologist and founder of Galleria Women's Health.

This is Health Talk with the Valley Health System, presented by The Valley. I'm Amanda Wilde. Dr. Kashyap, thank you for being here today.

Dr Deepali Kashyap: Thank you so much, Amanda, for having me here. This is a topic which is very close to my heart and I'm very passionate about it, so I'm very excited to be here talking with you.

Amanda Wilde (Host): Menopause happens to every woman, so I can imagine you are passionate about this because you know it's happening to you and every other female on earth at some point. And from my understanding, menopause means you no longer have periods, but there's a lot more to it. What exactly happens during menopause?

Dr Deepali Kashyap: So, menopause, I mean, you said it perfectly that, you know, it's a transitional phase where women go through physical and emotional changes. As the name suggests, menopause means pausing of menstrual cycles. So, that's exactly what is happening, that our ovaries basically are no longer making the hormones, which are doing a lot of important functions, and that's what women feel. Every woman goes through it at a different phase. We say mean age of menopause in the United States is 52, but some of us start experiencing it much sooner than others. But yeah, it can last for six, seven to even 10, 15 years and creates lots of problems.

Amanda Wilde (Host): So, what is happening to your body? Your periods stop, you stop ovulating, and you stop making certain hormones that are helpful.

Dr Deepali Kashyap: That is correct, but that's just part of the problem. Our ovaries make certain hormones like estrogen, progesterone, and testosterone. A lot of times we always think of testosterone as a male hormone, but it's very essential for women also. So when these levels start to decline, so declining level of estrogen gives hot flashes, night sweats, difficulty sleeping at night. Then, our progesterone is extremely important, which is very important for our mental wellbeing and for a lot of our cognitive functions. So, decline in progesterone makes us lose our sleep again. And also, that brain fogginess where a lot of time women complain to me, that, "Oh, I cannot think straight. I cannot remember things which I used to."

Then when it comes to testosterone, because testosterone again gives us that libido, the loss of testosterone can really have an impact on women's sexual health. There is loss of desire. At the same time, women tend to put on lot of weight and they have a hard time actually gaining muscle. It's only the fat that we are putting on and difficulty losing fat. But losing these hormones, it's just a part of the whole big system.

Another really important hormone, which is called cortisol, which is made by our adrenals and that controls a lot of our body functions. So, let's say, if I have to give you an example, so you know right now you and me, we are chatting, we are talking. But let's say the fire alarms wherever we are sitting goes off. Then, at this point, both of us, we wouldn't want to continue this conversation. All of a sudden you will feel that you're breathing heavily, your heart rate is higher and all your mind, because it detects danger, it wants to get out of here. So in this moment, you don't want to now eat, you don't want to drink, you don't want to go to the bathroom to have a bowel moment, you don't want to sleep, you don't want to have sex. All you want to do is just get out of this place, get to a safer place, and then we both will take a deep breath and be like, "Okay, now I can eat or drink or do whatever I want to do." And this reaction is supposed to last only for a few seconds or, let's say, a few minutes, maximum half an hour. After that, we are supposed to come back to our basal levels.

But a lot of us in our current society live in this really high cortisol state, where everything is a deadline. Every email, every meeting, everything is a deadline. So, imagine living like this for decades. So when we talk about menopause, I want to take a step back. Most of the women, we are talking about mid-40s, late 40s, and then early 50s. So if you think about all of our lives, this is the phase of our lives where most women I see, the kids are getting older, if they have kids, they're leaving home. Our parents are also getting older. They have diseases. They are dependent on us. So, women being mostly in charge of everything at home experience this not only internally if their body's kind of, I don't want to say failing them, but it's changing because the ovaries are not making those essential hormones. And then externally, our work, our children, our parents, everything falls on us. So, it's a lot on our plate.

So let's say, if we have a huge trash can, when it's empty, you can put a big box and nothing is going to fall out. But once it's full to the brim, now even if you put a paper clip, that's going to fall out. And I feel when we are around 50s, same thing happens because our bodies have been through so much that, initially, in our younger years you can do whatever and we are able to kind of bounce back. But now, after decades and decades of all this damage to our body, we get to a state where it kind of gets really hard to bounce back, plus these hormones make a huge impact, declining level of the hormones.

So, I think when we talk about menopause, it's really this transition, which is not only internal, but external combination of factors that make women experience these symptom, which like most commonly we said, I see the three most common things are hot flashes, foggy thinking, and then vaginal dryness. And then, of course, there are other things like bloating, difficulty losing weight, loss of desire, irritability, that are also kind of part and parcel of this, but this is exactly what is happening.

Amanda Wilde (Host): And osteoporosis is one of those common symptoms, isn't it?

Dr Deepali Kashyap: Because estrogen is very critical in maintaining our bone. So, our bone, you know, throughout our lives, we are constantly losing bone and we are constantly making new bone. There is a balance. And again, in our teens, in our 20s, we are making more bone than losing. But when we are in this menopause, perimenopause transition, lack of estrogen makes us lose more bone or lose bone faster than we can lay bone, and that's why there's weakening of the bone, which in medical terms you call osteopenia leading to osteoporosis.

Amanda Wilde (Host): So, there is hormone replacement therapy. Who is eligible for that and how does that work?

Dr Deepali Kashyap: Yes, and you're absolutely right. There is hormone replacement therapy, which basically as the name suggests, we're basically replacing the hormones. So when we talk about replacing, traditionally only estrogen, progesterone, but even testosterone can be repleted. When I see women and they want hormone replacement therapy, there's a very important step in assessing whether somebody is a right candidate or not. Because as much as we love hormone replacement therapy, it does carry certain risks. Like, there is theoretical risk of certain cancers. Then, there's also increased tendency to form clots or liver disease. This is what I screen out. Like if somebody is at risk of those, any particular like breast, ovarian, uterine cancer, or if a woman is at increased risk of having clots, then those are not the people where we want to give them hormone replacement therapy and increase their risk. So most commonly, like women who smoke or women who have underlying heart disease or women with seizures or who had pulmonary embolism or clots forming in their legs in the past, or somebody who has breast cancer or a lot of risk factor for breast cancer. Those are the people we try to avoid.

But I tell everyone that when I manage menopause, hormone replacement therapy is just one part of it because, as I said earlier, that there are a lot of things which make us experience these symptoms. So for me, it's more personalized approach. If you come to me, then I really want to talk to you and I want to understand what's going on in your life. Because wherever you are is different from somebody else, right? So, I try to understand what symptoms are you having, whether for you vaginal dryness is worse or not able to sleep is worse. If somebody is not in her current sexual relationship, she might not care about vaginal dryness. But if she's not able to sleep, that's worse, right? So, it depends what somebody's experiencing, how their lifestyle is. And I also focus a lot on the diet and how much somebody's moving, exercising. So, it's management of those things also, which is very, very critical. And on top of that, if this person is right, then we can replace some of the hormones, which makes a huge impact.

Amanda Wilde (Host): Are there other adjustments we can make to reduce symptoms either before menopause or during the time we're going through menopause, besides what you've mentioned, diet and hormone replacement therapy?

Dr Deepali Kashyap: There are a lot of herbal supplements that I use in my practice that can help to control these symptoms. So, these supplements are basically natural herbs that also helps and manage even our cortisol levels and our other hormones. When we think about our hormones, there's a different way to think about it. You know, our body makes hormones. So, what are hormones? They're basically chemicals which are made by one part of the body, and then they move around in our blood, and then they go to different organs, and that's where they work.

So right now, let's say in menopause, where we have lack of certain hormones, I think about it this way, what can we do to make whatever in our body last a little bit longer? Our hormones are made from some raw products, so even supplying our body with certain raw products, and a lot of times it's really good diet, which means a lot of green leafy vegetables, so if we provide it with that... And also good fat, we all run away from fat, but good fat is actually really good for us. So even providing our body with good fat, with vitamins, with minerals, which help in making more hormones

Then second thing, like I said, these hormones travel in our blood. So maybe providing it with the right environment, with the right messengers; you can say vehicles, like cars to move us around, providing right vehicles that can help these hormones to move around. Then, sensitivity, when these hormones reach any particular organ, they have to be able to enter that organ. So, increasing the sensitivity of our organs to these hormones makes a difference.

Then, a really important fact is removal of these hormones. So, estrogen breaks down into certain things, and some of those products are actually toxic, so they have to be eliminated from our body. So, many people nowadays are super constipated. So if somebody's constipated, then what happens is, even though they have hormones and they are not breaking down, and if they're not getting rid of a lot of these bad products, they also tend to accumulate in the body and can cause certain cancers. So, my role is always to assess somebody, see what is going on, and how can I make whatever their natural hormones are to last a little bit longer. Make sure that they're able to detoxify themselves properly, that even the ones they have, they're not causing the side effects. In fact, they're working for the betterment of the health.

And when it comes to hormone replacement therapy, there are multiple ways it can be given. We have certain hormones that can be taken as a pill form. Some can be used as creams. You might have heard of injections or pellets. So, there are a lot of different ways how we can put this hormones in our body.

When we talk about estrogen, estrogen is best used by putting it on the skin. We should not be taking estrogen by mouth, so by skin. Because these are fat-soluble hormones, so they're really absorbed very well through our skin. And by using them through skin, rather than the pill, the pill increases the risk of clotting with estrogen. Progesterone, it is best taken by pill at night. So women who have really hard time sleeping, they're good candidates. If they take progesterone by mouth, we say they literally sleep like a baby, they get really good sleep. And when it comes to testosterone, again through the skin. Again, testosterone, we don't want to take by mouth. Putting it on the skin or by pellets is a good way to give it to the body.

Amanda Wilde (Host): I like how you combine natural remedies along with medical remedies to help our bodies help itself. You mentioned that menopause happens average around age 52 and can last years. When it's over, how do we know it's over? Do the symptoms we just talked about end?

Dr Deepali Kashyap: So, you know, menopause, it's just a transition, going when the periods are over and then, we say, "Okay, you're post-menopausal." So, it doesn't really end. I mean, once the periods have stopped, we stay in that phase for the rest of our lives. Whether the symptoms go away or not, it varies from person to person. Some people have the symptoms for five years. Some will have for 10, 15 years. Some will have for a long, long time. And some might not have it at all. And again, what symptoms somebody has, that also varies. Sometimes it's just little bit of hot flashes. But symptoms like vaginal dryness, they can last for a long time.

As the estrogen keeps decreasing and decreasing, we might get used to some of the symptoms. We come up with days of sleep problems and all, but vaginal dryness, it doesn't go away. So, it has to be managed. Especially if somebody's in a sexual relationship, they might have to do something for a long time for it. I see a lot of women who come to me because they have severe vaginal dryness. And with vaginal dryness, the good thing is it can be easily managed. So, any women who has it, I don't want them to lose hope. I want them to remember that they can go see the doctor because we can easily treat it and it's such a life changer.

The way we treat it is, of course, there are hormones. There's an estrogen cream. And many people who are scared of using hormones, vaginal estrogen, there is just very small amount of systemic absorption. So, it can be used in a lot of situations and it is very safe. And it really, by repleting all that estrogen, can replete the lining of the vagina and really helps with the dryness, painful intercourse. And in women who have lots of urinary tract infections or vaginal infections, it can really help with a lot of those.

But let's say if you don't want to use estrogen, even then, we have other products which have like hyaluronic acid, which can help to build up healthy vaginal lining. In Nevada, CBD is used here, so there are a lot of vaginal products with CBD that can be used that also really helps in building collagen in the vaginal lining. Then, there are certain other techniques like radiofrequency where we help to build healthy vaginal lining, and all these can help to regenerate back to normal vaginal epithelium and help with the symptoms. Because many women describe that when they're having sex, it almost feels like sandpaper. And I understand that these are not life-threatening, but these symptoms really affect our quality of life and also relationships, which again impact our lives in general.

Amanda Wilde (Host): So when you're experiencing symptoms of menopause, know there are a range of options for you to choose from and talk with your gynecologist.

Dr Deepali Kashyap: Absolutely. This is our message today. Like, you know, if anybody wants to learn one thing from it, is if you're having anything, like you cannot sleep, you have foggy thinking, you feel like, "I'm tired of weight" or "I'm constantly bloated," just don't lose hope. Go and talk to the right person and you will be able to find the solution. Nobody should be living with these.

Amanda Wilde (Host): Dr. Kashyap, thank you for a comprehensive and enlightening conversation about menopause and for clueing us in on some strategies to manage the challenges of menopause. Really appreciate your time.

Dr Deepali Kashyap: Thank you so much, Amanda.

Amanda Wilde (Host): That was Dr. Deepali Kashyap, functional gynecologist and founder of Galleria Women's Health. For more information, visit valleyhealthsystemlv.com. 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. Thanks for listening to this episode of Health Talk with the Valley Health System, presented by The Valley. I'm Amanda Wilde. Be well.

disclaimer: Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.