EPISODE OVERVIEW:

Join Betty as she sits down with Dr. Sonia Novotny, a board-certified OB-GYN and Menopause Society member, to demystify perimenopause and menopause. From night sweats to mood swings and everything in between, Dr. Novotny breaks down what’s really happening inside your body during this transition—and why. Discover which symptoms are normal, which ones need attention, and what science-backed treatments actually work. Whether you’re in the thick of it or just want to know what’s ahead, this conversation will leave you feeling informed, validated, and ready to take charge of your health.

TIME STAMPS:

[4:33] Menopause Knowledge

• Importance of evidence
• Menopause Society and SWAN Study

[13:39] Menopause Symptom 

• Symptom durations
• Menopause experiences

[21:22] Perimenopause

• When to seek evaluation
• Help for irregular bleeding

[1:03:52] Finding Providers

• Scheduling consults
• Finding knowledgeable partners

[1:13:33] Healthy Aging

• Importance of social engagement
• Healthy aging strategies

KEY TAKEAWAYS: 

• Importance of women’s health – Discover how your health needs evolve as you age and why staying informed matters now more than ever
• Evidence-based information – Learn why finding reliable, science-backed resources is crucial for understanding menopause and making informed decisions
• Options for care – Explore why individualized care matters and what treatment options are available to manage your unique symptoms
• The role of lifestyle changes – Find out how practical adjustments to your daily routine can help you manage menopause symptoms effectively
• Biological changes for women – Understand the hormonal and physical changes your body goes through during menopause and what they mean for you

GUEST INFO: 

Dr. Sonia Novotny, OBGYN doctor

• Website
• Instagram
• Swan: Study of Women’s Health Across the Nation
• The Menopause Society

RESOURCES: 

• Join Betty in a free consultation call for your financial goals
• Subscribe to the Betty’s Smart Friends YouTube Channel
• Follow us on Instagram
• Visit my website for more info
• Follow us on LinkedIn

Betty Wang is an investment adviser representative of BW Financial LLC, a registered investment adviser registered in the State of Colorado. Registration does not imply a certain level of skill or training. The views and opinions expressed are as of the date of publication and are subject to change. The content is for informational or educational purposes only, and is not intended as individualized investment advice. This information should not be relied upon as the sole factor in an investment-making decision. You are encouraged to consult with a financial professional to address your specific needs and circumstances.

TRANSCRIPTION: 

Automatically Transcribed With Podsqueeze

Betty Wang 00:00:05 If you are a woman over the age of 40, you are probably getting bombarded with information about perimenopause and menopause. And while it’s great that we are finally talking about this natural transition that all women experience, sifting through all the information, what’s fact, what’s not can be difficult and overwhelming. Today we’re going to talk about women’s health, what you need to know, and of course the transition to menopause. I’m Betty Wang, host of Betty Smart Friends. I’m a certified financial planner who helps women be more empowered and feel less alone in their financial lives today. Joining us to help us filter through all the information out there is Doctor Sonia Novotny. Sonia is a board certified ob gyn and member of the Menopause Society. She’s practiced at Kaiser Permanente for almost 14 years and is the associate medical director for the Metro ob OB-GYN department. Sonia is passionate about women’s health and supporting women through all of life’s journeys. She listens to her patients and empowers them with information based on science and evidence, so that women can make the best healthcare decisions for themselves.

Betty Wang 00:01:15 I’m so excited for Sonia to share her knowledge and experience with us. Please welcome Doctor Sonia Novotny to the podcast.

Dr. Sonia Novotny 00:01:23 Oh thanks buddy. What an introduction. Thank you.

Betty Wang 00:01:26 Thank you for joining us. I’m excited for us to chat about this in our private conversations. I found you super knowledgeable and loved your approach with how you talk with patients and how science based it is, right?

Dr. Sonia Novotny 00:01:39 Oh, thanks.

Betty Wang 00:01:40 Can you tell the listeners a little bit about your background? I mean, obviously you’re a you’re a doctor.

Dr. Sonia Novotny 00:01:47 Yeah, yeah. So I live here in Denver, Colorado and got to meet Betty through our sons. They’re in a robotics club together. So that’s been really fun. And so I graduated from Cherry Creek High School, where our kids went, and I still get to live in the neighborhood, and it’s fun to see my kids go to the same schools. I went to Rice University in Houston for undergraduate, and I met my husband, John, there. He’s an electrical engineer. And then I came back to Colorado for medical school at the University of Colorado.

Dr. Sonia Novotny 00:02:14 And I wasn’t sure if I wanted to do family medicine or surgery, but I found ob gyn to be a really great combination of all those things, and it was always exciting. I felt like you were always getting to interact with people at some of the most important times of their life, you know, thinking about being sexually active, what it means to prevent infections, to prevent pregnancy, and then trying to become pregnant and thinking about fertility and like what an important time of life that is, and then supporting people through their pregnancies and now supporting people through menopause and all that comes with it. So it’s been a really exciting field for me, and I get to do so many things from routine preventive care, to troubleshooting problems, to delivering babies, to doing surgeries. And one of the things that I’ve enjoyed the most is menopausal care. So when I was a medical student at the University of Colorado, I chose my residency as one that would kind of help me start a career with Kaiser Permanente, because I really found it to be the kind of model of care that I wanted to deliver.

Dr. Sonia Novotny 00:03:19 That was evidence based, not fee for service, meaning that I really get to offer people the things that I believe in, and I don’t necessarily have a financial incentive in what they choose. I don’t make more money by ordering more tests. I don’t make more money by recommending specific treatments. And so I’ve really been thankful for that in my career that I really get to present my patients with the options that I really believe in and think our best, and I am happy with whatever they choose. I will order whatever labs that they feel they need or whatever treatments that they think suits them best. And I really just get to keep my role as giving them the best information that I have. That being said, everything is always changing, especially when it comes to menopause. So things that I thought were true ten years ago are not true today, and I’m sure a lot of the information that I will share will be changing and will be adopting new ideas and new technologies. So I’m really aware of that and really humble that things are changing.

Dr. Sonia Novotny 00:04:17 I don’t know everything, and there are so many ways to approach this, and I liked that you said that a lot of people are talking about menopause because they feel like I’m always hearing that nobody’s talking about it, and that really makes me sad. And that’s why I was so excited when you invited me to this podcast, because of course, in my world, I’m always talking about menopause. But I realized that especially now, people get a very distinct algorithm or feed where maybe they’re only hearing about menopause like me. Like even my New York Times feed is all about menopause. But I can understand that that may not be the algorithm that everybody gets. I listen to a lot of podcasts on menopause, too, and I don’t know where I heard it, but someone once said something that really resonated with me that even though everyone might be talking about it, nobody is talking about your specific menopause journey. So it’s always going to feel like to some people that maybe nobody’s talking about it because no one is going to have the same experience as you in the same path as you.

Dr. Sonia Novotny 00:05:19 Which I think really gets to the root of it, that it’s such a personalized journey and no one is going to have the same constellation of symptoms, and no one is going to benefit from the same therapies. So I’m excited to just give you some insight into how I think about it, how I present it to my patients, because I know it’s going to be different even from my other partners at Kaiser. Definitely, you know, different providers and different venues. And I think it’s nice for people to just get a lot of different perspectives because pieces of what I say or other podcasts or, you know, other sources are going to suit everyone better.

Betty Wang 00:05:55 Yeah, I must have must be on the same algorithm as you. Because and really, part of the reason I started this podcast is because literally all my friends and I talk about are perimenopause and menopause and what we don’t know, what we do know, and sharing little tips that we’ve heard here and there. You know, I’ve gotten to the point where if I get a paper cut, I blame perimenopause because I really think it seems like everything that’s going sideways, like some somebody cuts me off in traffic, perimenopause.

Betty Wang 00:06:28 Like, it just it seems like all these changes, it’s just very hard to know what to do and where to find information. Right.

Dr. Sonia Novotny 00:06:38 Yeah. No, I hear that. And as someone who’s. Yeah, like consuming a lot of this information, I also, like, struggle to, like, really have a clear picture of, you know, what I want to say and what I believe in. So it’s a lot to wade through. So I’m also a member of the Menopause Society. It used to be called the North American Menopause Society or NAMs. I had a Nam certification before Covid that I let lapse after, and I’ll probably restart that again. And so that’s a good resource. The Menopause Society, they also have a provider database. And you can search for physicians and nurse practitioners or advanced practice providers who are certified through the Menopause Society. A lot of our data comes from a study called the Swan study. And this Swan study actually has their own website, which is like really, really high quality.

Dr. Sonia Novotny 00:07:31 It’s called Swan study. And we’re really lucky. The woman who’s the president this year is from the University of Colorado. Her name is Nanette Santoro. She’s a reproductive endocrinologist on staff at the University of Colorado, and she is very active in publications and Organizations. She speaks a lot. And so there’s there’s a lot of good data there. And the Swann study is like a longitudinal study that’s been going on for a lot of years and a lot of locations. And as Kaiser, we also have patients that have contributed to that data set. So a lot of the information. So I kind of use the facts and figures that come from the Menopause Society. And they get a lot of their data from the Swan study. So I think those are really great places to go for information. And that’s sort of kind of the mindset that I come from.

Betty Wang 00:08:21 Hi there. Thanks for listening to Betty Smart Friends. Here’s a quick money tip that I share with clients. Automate your savings. Set up automatic transfers to your savings accounts to ensure you consistently save a portion of your income.

Betty Wang 00:08:35 This can help you build an emergency fund and save for future goals without having to think about it. Remember, you’re not alone. Now back to the show. I guess for those of us who don’t have the medical background, how do you how do you approach your patients? Like how do you bring up these discussions? Because it seems like I’m just maybe I’m not alone that we’re just hearing about this, right? Like, I wish I had known that perimenopause could start at age 40, right? Yeah. Like, it seems like you were kind of ahead of your time, or they had a lot of foresight by joining this menopause society. You know, 5 or 6 years ago or before, prior to Covid. How do you typically approach or when do you start having these conversations with your patients?

Dr. Sonia Novotny 00:09:27 Yeah, yeah, I definitely you know, a lot of people have concerns about, you know, they feel tired, they feel like they’re gaining weight and they want to talk about menopause. And like you said, can it be perimenopause or menopause? Yes, absolutely.

Dr. Sonia Novotny 00:09:40 Almost everything can be linked to that.

Betty Wang 00:09:42 My papercut. Yeah.

Dr. Sonia Novotny 00:09:44 Probably. No. Being alive and aging. And overall, I guess what I want to say is that I think that this is a normal physiologic pathway, and we’re all going to experience it differently. And for some people, some of these things can be managed. You know, in being the healthiest version of themselves and giving it a lot of time. But there truly are people who are struggling and want more interventions. And that is very reasonable too. And just sort of understanding the lay of the land and all the options that are out there can help you make the best decisions. And and so, you know, sometimes I hear podcasts where people think that, like, everyone needs to be on this set of supplements or treatments or that, and I don’t I don’t believe in that. But I certainly believe that there are people who need more and people who might not need as much at different times. So I just always start with just the definitions.

Dr. Sonia Novotny 00:10:37 And so the first thing is just understanding, like our reproductive life and fertility. My kids hear this Discussion all the time. And I have heard both little boys. Not little teenage boys. And I have heard. I’ve overheard them explaining the menstrual cycle. I don’t think that that’s very popular when you explain the cycle to girls. They have told me that does not win friends. The way I explain it, which I’ve heard them also say, is, you know, when you are an embryo, you have the most eggs that you’ll ever have, about 5 million. And by the time you’re born, those have already, you know, kind of been absorbed by your body, that now you only have about a million eggs by the time someone is born, by the time someone goes through puberty and starts their period or menarche, there’s only 500,000. And so with each menstrual cycle, you are losing eggs. And so this just gets the concept of reproductive aging. So by the time you’re in menopause which clinically just means 12 months of no periods.

Dr. Sonia Novotny 00:11:39 And that’s for women who aren’t, you know, haven’t had a surgery that makes them have their period stop or don’t have an IUD that stops their period. Like in the absence of surgeries or medications. 12 months of no period. That is menopause and you essentially have no eggs. That can happen naturally anytime after the age of 40. If it happens before, that’s premature ovarian insufficiency. And that needs a very specific workup because there could be genetic issues at play. And it’s worth having a very thorough evaluation. And those women should get treated with hormones, because having premature ovarian insufficiency has big repercussions on your bones and your heart and your overall health when this process happens after age 40. That’s within normal. The average age for menopause is between 51 and 52. If this happens before age 45, that’s on the early side. And if it happens after age 55, that’s on the late side. But average means, you know, half of women won’t go through menopause until they’re 52. So there’s such a huge range.

Dr. Sonia Novotny 00:12:45 We have some good ideas about how long your symptoms will last by a big kind of model called straw stages of reproductive aging. But the windows are really, really big. So in my sort of truncated view of it, if you have hot flushes and you’ve noticed that your cycles have changed, there’s more spaced out or closer together. On average, you can expect that your period would stop within five years. Okay, so that’s a really big window. We know that women who describe their ethnicity as Asian, Chinese or Japanese on average have a shorter duration of menopausal symptoms 4 to 5 years. Maybe it’s the diet, and women who are black will have a longer duration of symptoms on average ten years. So there’s a lot of difference in the length of symptoms. We know that things that can make the symptoms more intense are having a higher weight. Smoking. Alcohol use. Sedentary lifestyle. Life stressors. Anxiety. Those can make menopausal symptoms worse.

Betty Wang 00:13:53 No. Just do the symptoms stop after menopause? Yeah, I guess I’m asking for a friend.

Dr. Sonia Novotny 00:14:04 So they get better for most people. And when I started, you know, doing this work. Our thought process was like, you won’t need these after time. Like, everyone just needs to be off hormones. Like, all of these symptoms will stop. We have really good data from this one study that a lot of people, probably 40% of people, continue to have hot flushes or they bothersome enough to want prescription medication. Maybe not. You know, maybe that they’re much less. But it’s it’s it’s a huge portion of women that will have ongoing symptoms, but they they probably will be better. The reason that they’re so difficult in perimenopause is that you have these very irregular cycles. So because you have less eggs and their quality is so low, in some cycles you will ovulate, you know, and you’ll kind of go through these normal ups and downs of estrogen, which is the first part of the cycle. And then usually when you ovulate now it becomes a progesterone dominant part of the cycle, the luteal phase.

Dr. Sonia Novotny 00:15:08 And you may not ever get into the luteal phase for a month or two. And then you ovulate and you do. And so you have these huge fluxes of hormones. And that’s what makes hot flushes so severe. Most people will have hot flushes or, you know, the sensation of feeling warm and sweaty at night. Those are a lot more common than daytime. Yes, yes. And that’s a really big deal. You know, when it’s happening at night, it is. Fragmenting your sleep and getting poor sleep affects everything. It affects your energy. It affects your mood. It affects so much, you know. More inflammation in your body from having poor sleep, increased cortisol levels. So when people say that they’re noticing fatigue or weight gain is it menopause? Yes. But a lot of it can just be like the natural changes in metabolism and aging. But that’s, you know, a place that we can really target and talk to people about opportunities to help them there. One really big thing that I see as like a generalist ob gyn is irregular bleeding problems.

Dr. Sonia Novotny 00:16:10 And so because you have such irregular cycles, there’s a huge opportunity for irregular bleeding. And these are going to be exacerbated for people who are higher. Wait, which is most of us, because our fat cells also make estrogens. So the ovaries make a more potent form of estrogen called estradiol. And so in perimenopause, you still do have estradiol and On progesterone from the ovaries. But when you’re post-menopausal, those levels are extremely low, virtually zero. But you are still getting estrogen from other tissues, specifically your fat cells. They make a weak form of estrogen called estrone.

Betty Wang 00:16:50 Could you talk about what exactly estrogen does? Like, yeah. What is is is that the reason like my skin’s drying out, like my hair is falling out or what is like, what does it do for you?

Dr. Sonia Novotny 00:17:04 Right. Right. So estrogen is, you know, the dominant hormone of the first part of the menstrual cycle, the follicular phase. And so in that estrogen dominant stage of the cycle, all the follicles, many follicles are competing to be the dominant follicle that you would ovulate.

Dr. Sonia Novotny 00:17:20 And in perimenopause sometimes you can get stuck in that cycle. And that’s especially why people can have like more breast tenderness or other symptoms. So many of our tissues are estrogen dependent. So being in perimenopause or menopause, where you have lower levels because there’s that flux in perimenopause and in menopause solidly, when you’ve had 12 months of know periods, your estradiol levels from the from the ovaries are really low. And we know that definitely the tissues of the vagina, the vulva, the urethra, which is the entrance to the bladder, they’re super, super estrogen dependent. So beyond hot flushes, the number two complaint is vaginal dryness, painful intercourse, bladder irritation, frequent urinary tract infections because those tissues are just so estrogen dependent. So a lot of those are like very, very common symptoms. And those don’t get better. Unfortunately, as you go through menopause, the hot flush is yes, because you don’t have these huge fluxes, but you’re going to be in a chronically low estrogen state in an ongoing way when you’re in menopause.

Dr. Sonia Novotny 00:18:29 We also know that collagen is estrogen dependent. So what people what you are noticing about changes in skin or joints is real because yeah, collagen is very estrogen dependent. So a lot of people do notice skin changes in elasticity, joint changes, those sorts of things. So those are those are real.

Betty Wang 00:18:49 What other symptoms do people come to you with that you know, those are big ones it sounds like. But like I have not really. Well, I guess I had heard about the vaginal dryness, but but you know, it’s it’s interesting to hear what you see. What finally brings women to bring it up. Right. Because I think I shared a statistic with you that the World Health Organization that only 49% of women in perimenopause spoke to a health professional. I mean, if I had known that I had started earlier, I probably would have. I just I was in my 40s. You’re raising kids, you’re tired. Like that’s you just think that that’s just life. Now, looking back in hindsight, I’m like, oh, I wonder if those were symptoms of something else that I maybe you should have known to address or started to address earlier.

Betty Wang 00:19:43 What what symptoms do people most come to you with after those two biggies? Right.

Dr. Sonia Novotny 00:19:48 Right, right. So actually, statistically, the thing that brings most perimenopausal women in is irregular bleeding.

Betty Wang 00:19:55 Okay.

Dr. Sonia Novotny 00:19:55 Yeah. So 70% of visits by perimenopausal women are for regular bleeding, according to the Menopause Society. So that’s a big opportunity to talk to people about this process, about, you know, the physiology of what’s happening and to start talking about treatments. When someone has irregular bleeding in this time, it’s usually because of these ovulatory cycles. And one thing just to put a plug in is we want to make sure that this isn’t any a sign for anything more worrisome. So if you have more than one bleed in a month, if you have a prolonged bleed, meaning like more than seven days, Very heavy. We need to see you in OB-GYN. The things that we think about are to do a biopsy inside the uterus, to make sure this isn’t a sign for overgrowth of the lining of the uterus or cancer.

Dr. Sonia Novotny 00:20:41 We know that up to 5% of women with irregular bleeding that’s prolonged and heavy and frequent really could have uterine cancer or endometrial cancer. Those are the same things. The incidence of this is going up because more people have more estrogen in their bodies because of higher weight. Being overweight or obese are the biggest risk factors for endometrial cancer. So we do want to make sure we’re not missing that. We also think about infections about structural issues that could cause bleeding. So fibroids or polyps those are usually benign growths in the uterus. And those can be more common in perimenopause. Just because you can have much higher levels of estrogen or more prolonged exposure to the estrogen part of the cycle. Once we’ve made sure that, you know, those things aren’t happening and that we’ve addressed those more specifically. For people who don’t have an ongoing issue with this, you may not need treatment, but a lot of times the treatment could be to add progesterone because that’s what you’re missing in this cycle. So that could be an oral medication.

Dr. Sonia Novotny 00:21:42 It could be a more long acting progesterone like a Marina IUD. I’m a huge fan of the Marina IUD, and it’s a really nice thing for people who are perimenopausal because it sits right in the uterus, giving a very small and steady state dose of progesterone so you can, you know, have some protection against this irregular bleeding of perimenopause. And it also gives you a birth control method, because it’s really important to say that fertility declines every decade, but you are not infertile in periods. And so people absolutely do become pregnant because if you have any periods, you can become pregnant. Yes, your fertile potential is much lower than it was in your 20s and your 30s. but if you get periods, you can still become pregnant, and you still do need to think about having a birth control method, because becoming pregnant in your late 40s and early 50s has a lot of complications associated with it. Also, you know, very high risk for miscarriage, but a higher risk for hypertensive disorders, for twins, for complications with the delivery.

Dr. Sonia Novotny 00:22:46 So it’s yeah, just worth putting that plug in.

Betty Wang 00:22:49 Yeah. Can you explain what progesterone like low progesterone like what symptoms come about for just so that we understand what it does.

Dr. Sonia Novotny 00:22:58 Yeah yeah yeah. So progesterone is the dominant hormone of the second part of the menstrual cycle. The luteal phase that comes after ovulation. And so some people might notice that they feel a little bit moodier with progesterone. It’s the hormone that kind of stabilizes the lining of the uterus. And so when you don’t have that progesterone, when you’re like in an estrogen dominant cycle, you may have irregular bleeding. So adding the progesterone can stabilize the lining and regulate bleeding. And so sometimes taking oral progesterone for some women it can cause mood changes. Everyone is really different. But that hormone is more of a culprit. So getting progesterone through an IUD where it’s not circulating through your bloodstream can be a nice option for people. The Marina is FDA approved for eight years as a birth control method, but five years if you’re using it more for bleeding irregularities.

Dr. Sonia Novotny 00:23:56 We do use it to balance hormone replacement therapy, which I’m sure we’ll get to here soon, but that’s not what it’s FDA approved for. But it’s a very common use of it. And so we would use it for five years if it’s balancing estrogen replacement therapy.

Betty Wang 00:24:12 I guess I’m just trying to understand how do you know what the right balance is like? Yeah, I’m sure it’s kind of art and science or you know, we hate to hear that it’s trial and error because it but it sounds like it might be a little bit.

Dr. Sonia Novotny 00:24:28 It is I know, I know.

Betty Wang 00:24:31 Yeah yeah.

Multiple Speakers 00:24:32 Yeah I.

Dr. Sonia Novotny 00:24:32 Wish the female hormones had more transparency, but they don’t because you and I could have the same exact levels of estrogen and progesterone and feel very, very different. The normal range of hormones is super, super wide. So when people who have like pretty regular cycles, you know, come to me saying, I don’t feel, well, I think it’s my hormones, I say, it really could be.

Dr. Sonia Novotny 00:24:58 Unfortunately, doing your labs, if you’re getting a regular period especially, it won’t give us much insight. In my world, I am happy to check whatever would give you peace of mind, but the normal range is really wide and I know you’re in the normal range. If you still get mostly a monthly period, every day of your cycle will have a different balance of estrogen and progesterone. And so checking these labs is not always that useful, because we can’t say that at this level you feel poorly in this level. You feel well, it’s you know, some hormones are kind of like that, like thyroid hormone. But the female hormones aren’t like that. Testing hormone still can be useful if people have reasons to not quite know if they’re in menopause. Like for example, if you’re like me and you have a marine IUD, I haven’t had a bleed in 15 years. And so I may not know, you know, when I’m going to be in menopause. And so checking an FSH can be really useful.

Dr. Sonia Novotny 00:25:55 That’s the hormone that your brain sends to the ovaries. And so if your ovaries are working normally that FSH should be pretty low. But if your ovaries are pretty quiet like you’re at the end stages of perimenopause or you’re post-menopausal, they’re not putting out much hormone, and the brain has to send a really big signal to the ovaries. And so we’d expect that FSH to be high, at least a level of 25 or greater. The way we kind of think about hormones is a little tricky, since we don’t have great noma grams, so we kind of think about it in the setting of fertility because we have a lot of information there. So checking hormones roughly on day three of your cycle, it could be really the range of day two through five is sort of our standard on how to interpret these levels. Because, you know, FSH and estradiol, they fluctuate so much. So having like these day three labs, day one is the first day of your bleeding. And so checking labs on day three can give us more information because that’s how we assess people’s fertility.

Dr. Sonia Novotny 00:26:57 And so when we’re thinking about fertility and you want your FSH to be less than ten on day three to say that you have normal fertility, an FSH greater than ten means that you have diminished egg quality, and an FSH greater than 25 means a chance of getting pregnant, are extremely low, and you don’t even need a birth control method. So sometimes we check those labs because, you know, people might wonder, like, should I replace my IUD? Do I even need this? Or I don’t know where I am in this cycle because I’ve had an IUD or I have my uterus out, but I still have my ovaries. Or maybe someone has had an ablation where we burn the lining of the uterus because of irregular bleeding. And so those people may not know.

Betty Wang 00:27:40 Yeah, because I’ve had a couple of friends who are like, oh, I got a blood test and they told me I’m in menopause. And I just so it’s likely that FSH test not like the harm, not the other like estrogen progesterone tests.

Dr. Sonia Novotny 00:27:57 Those are really hard because you’re getting estrogen from other parts of your body from your fat cells. And then there’s also the interconversion of testosterone and estrogen. And we get most of our testosterone from the adrenal glands, little glands that sit on top of the kidneys. And they make testosterone our whole life. But they the amount of testosterone just declines gradually as part of aging. Not necessarily like menopause, but people can notice that they, you know, some of the things that we associate with testosterone, like libido or energy, do get lower in menopause because you do get testosterone from the interconversion of estrogen from your ovaries to testosterone. So your overall testosterone does decline in menopause from that. And also just like the natural age related decline, if that makes sense. And so for people who aren’t quite sure where they are, FSH is a big hormone to test. But that being said, it’s a proxy for menopause because menopause is really 12 months of no bleeding. So if you still do, you know, have your uterus and you haven’t had an ablation, I can’t promise you that you won’t bleed with an FSH greater than 25.

Dr. Sonia Novotny 00:29:07 But I can say that you are very likely to stop your periods very soon in the next 1 to 2 years that you don’t need a birth control method.

Betty Wang 00:29:15 So I guess let’s jump into treatments, because I do. I’ve had I’ve heard of people starting testosterone as part of their overall health strategy. I mean, the HRT is obviously something that, you know, we’ve talked about the Marina, can you explain is testosterone part of the HRT or I guess let’s start with. Okay. They come in. Yeah. They have a regular bleeding. So that’s where we sort of start with possibly the Marina and then let’s say symptoms continue to get worse. Night sweats come the hair loss of weight gain, insomnia, loss of libido. You know, mood changes. Yeah. Where do we go? There.

Multiple Speakers 00:29:59 Yeah, absolutely.

Dr. Sonia Novotny 00:30:00 And I would say yeah.

Betty Wang 00:30:01 I mean, I know it’s not linear, right?

Dr. Sonia Novotny 00:30:04 But I definitely see this scenario all the time. Yeah. Yeah. And so I just start by talking about that.

Dr. Sonia Novotny 00:30:11 This is, you know, a normal process. It doesn’t have to be always something that’s considered pathologic, because for some people it’s really manageable. And they may not want a prescription treatment that some of the wellness things that seem very simple are very powerful exercising regularly, getting a healthy diet rich and fruits and vegetables and antioxidants. A high protein diet like a mediterranean sort of diet has been shown to be a really big deal. Limiting alcohol intake to ideally less than a drink or day. Ideally a lot less than that, but definitely no more than a drink or day. Not smoking, you know, regulating your caffeine intake. Those are really, really powerful. So it’s worth saying, even though a lot of people are already very diligent about doing those things, but they’re they’re meaningful and impactful.

Betty Wang 00:31:00 Well, while you’re on, what do you think about the weighted vests? Right. I’ve. Oh, I started doing that. I’ve started to sing more people because I had read the menopause book by doctor.

Betty Wang 00:31:12 I can’t. She’s everywhere now, but I have started to notice other people wearing them. Even in California when over spring break I saw. Is that helpful? Is that the white bear? You know, I think it’s touted as helping you with weight bearing and posture. What are your thoughts on that?

Dr. Sonia Novotny 00:31:33 Yeah, I you know, a lot more than me about these weighted best. I can definitely say that like all exercise is good exercise. That like weight bearing exercise in specific is a big deal for perimenopause and menopause because we really need to work on protecting our bones. Our bones are really metabolically active. You know, they’re kind of getting destroyed and built up at the same time. And that equilibrium shifts in menopause, and they’re getting destroyed by ourselves faster than they’re getting built up. And so we want to be very careful that we are getting that weight bearing exercise in any way possible. So I need to look more into these weighted vests. best? But that’s totally amazing. And any form of weight bearing exercise and being really aware of bone protection is a big deal for perimenopause.

Betty Wang 00:32:19 What’s considered weight bearing exercise like? So I guess wearing a weighted vest, strength training. But you know, is yoga or Pilates where it’s you’re using muscles but you’re not I mean, you’re not using heavy weights. Is that is that can that be considered your weight bearing exercise or do you really need to wear a weighted vest or add weights? I mean, that’s always been a little confusing to me.

Dr. Sonia Novotny 00:32:47 Right, right. I think lots of parts of yoga where you’re using your own body weight to create resistance does count as weight bearing exercise, but also doing like more dedicated strength training. You know, with weights, they don’t have to be big, but peripheral weights and, you know, machines that help with that, I think should be our goal. I am not perfect at any of those. I, I don’t have a perfect solution. I am just trying. So I think whatever you can do that makes sense to you to do both cardio and to get that weight resistance is you’re winning.

Dr. Sonia Novotny 00:33:21 Yeah.

Betty Wang 00:33:22 I guess while we’re still talking about, you know, lifestyle changes before we get to the hormone treatments is what are your thoughts on vitamins and supplements? I mean, again, this menopause book touted creatine and lots of different vitamins to help sleep fiber. And it’s hard for us to know what we should or shouldn’t be doing. Do you recommend any supplements or what are your thoughts on that? And I guess, should people start with that first before like trying I guess hormones or something or medicine?

Dr. Sonia Novotny 00:34:00 Yeah, yeah, supplements are really hard because they’re not regulated by the FDA, so they don’t tend to get as good quality studies as our prescription medications do. I definitely think that there is a lot of benefit that we are still learning about, so I definitely am excited to learn more. I will say that from my perspective, there’s not a lot of high quality data to recommend the supplements as treatments for hot flushes or night sweats of menopause. These supplements can be really expensive. And so I think that for people who have that financial capability or energy or time to do those, most of these things are not dangerous.

Dr. Sonia Novotny 00:34:44 But I cannot promise outcomes from them. I think having a healthy diet, focusing on fruits and vegetables, fresh foods, limiting processed foods, increasing protein in your diet, getting whole grains and fibers, which is hard to do. But if you can do those, that’s essential. You need calcium if you can get that through your diet. Amazing. I know a lot of people aren’t able to get a lot of calcium through their diet. Dairy products work, you know. Yogurt, cheese. Foods that are fortified, like almond milks or soy milks that are fortified can count. If you can get 3 to 4 servings of foods with calcium. You’re set and you can get the calcium that your bones need. But if you’re not able to, I do recommend a calcium supplement with vitamin D because most of us are deficient. So that’s the supplement that I do recommend calcium with vitamin D. But if people can get these through their diet. That’s that’s my perspective. I know there’s so much information coming, but I don’t think at this moment there are enough high quality studies for me to really tell my patients who are, you know, maybe working two jobs and are single moms and really trying to be judicious with their time and money, that there’s good data for that.

Dr. Sonia Novotny 00:35:58 But I think if someone has the energy for those things, most of these things are not dangerous and you can absolutely try them. And I’d love to hear about those experiences, but I’m not recommending those in my practice.

Betty Wang 00:36:09 No, I mean, that’s a really good perspective, right? Because we just don’t know. Yeah, a lot of it is being touted and people say it very strongly. So it’s. Yeah. And if you hear it enough, right, you’re like, oh well maybe there is something to it. Right. And it’s usually I’ve also heard magnesium and the biotin and it’s, it’s hard to know what to, to, to take in. Right.

Dr. Sonia Novotny 00:36:34 Right. I mean, I think that there’s good data that magnesium can help. Muscle spasms or leg cramps and restless legs can really be a contributing factor to poor sleep. You know, not all poor sleep is perimenopause. You know, it could be restless, but it’s not. It could be. But, you know, it’s worse if, you know poor sleep is your main complaint.

Dr. Sonia Novotny 00:36:54 We also want to think about other things. Like your thyroid, restless legs. Could you have sleep apnea? Other diseases? Diabetes can affect sleep. So it’s worthwhile, you know, talking to your physician about these things, too. But I don’t have all the answers. I’m certainly open to hearing more things. And sometimes I listen to podcasts, and people have, like, a very beautiful list of all these supplements that you should take. And I wish I really could also get on board with that because it sounds so nice. Like, you just take this combination of things and you will feel great. Yeah, but unfortunately I don’t think that there’s strong data for that. There was a lot of excitement about black Cohost, which is a plant based form of estrogen. And when we have smaller studies, it shows benefit. But when it gets big studies, it doesn’t truly show to have benefit. The same goes for evening primrose oil. I have lots of patients who swear by those things. I think they’re very safe things to try.

Dr. Sonia Novotny 00:37:49 And if you are a person who really likes to try natural things first, I think that’s appropriate. But if you’re saying that you are suffering and you can barely work and take care of yourself and your kids, I want to let you know that there are things that are better proven, and you may not want to kind of try those things. It may not be worth your time and money. The only people who shouldn’t do black kosher people that have chronic liver disease. So it’s safe for most people.

Betty Wang 00:38:14 So yeah, that’s a great segue to so what do you recommend? Right. What’s the next step?

Dr. Sonia Novotny 00:38:19 Yeah, yeah. So I present people like lifestyle things that we should probably all be doing.

Betty Wang 00:38:25 Yes we would all yes. I wish that came in a pill too. Yes.

Multiple Speakers 00:38:30 I know exactly. That’d be great for me.

Dr. Sonia Novotny 00:38:33 And so I do, you know, tell people that these supplements are out there. The data to show their efficacy is limited. But I have a lot of people who say, actually, that’s that’s for me.

Dr. Sonia Novotny 00:38:42 That’s what I want to try. And I am happy for them. And I ask them to let me know how it’s going, because if it’s great, then perfect, but otherwise then I can talk to them about prescription options. The next sort of category of medications I talk about are the SSRIs selective serotonin reuptake inhibitors. So this class of medicines was initially marketed for mood changes, anxiety and depression. But we know that increasing serotonin, which these medications do to help mood, is also part of the hot flush pathway.

Multiple Speakers 00:39:15 So yeah. So this can.

Dr. Sonia Novotny 00:39:16 Be an option for a lot of people. One of these medications Paxil or Paroxetine, the manufacturers went to the trouble of getting an FDA approval. So we know that ten milligrams of Paxil is really effective at treating hot flushes. It’s not as effective as hormone replacement therapy, which we’ll talk about next. But it can help like 40 to 60% of people. So there are people who may not want hormone replacement therapy, who have a strong family history of breast cancer because some cancers are hormone dependent.

Dr. Sonia Novotny 00:39:49 So if you have a strong family history of breast cancer or being treated for breast cancer yourself, or if you have uterine cancer or you have contraindications to hormones, so beyond those cancers, that would be a really high risk for heart disease or blood clots. This may be a good thing for you to try. We know that other medications in this class also help hot flushes. It doesn’t just have to be Paxil, even though that’s the one with the FDA approval. So the one that we use most commonly in practice is Effexor or Venlafaxine. That one does help. Pexels. More like 40 to 60% of people. And Effexor is more like 50 to 60% of people. So it doesn’t help everybody. But it’s definitely an option for people who don’t want hormones or have health reasons. That would make that not a good first line treatment. You would need to take these medications for at least four weeks to see the benefit. They’re not immediate. They will not help with vaginal dryness. They will not help with libido.

Dr. Sonia Novotny 00:40:48 And in some cases they can actually decrease libido. So it’s important to know their limitations. They’re really shown to just help with hot flushes. A lot of people notice mood changes and menopause. And that’s that’s tricky because there’s lots of. Kind of lifestyle things that are happening around the time of menopause. That may be contributing to that for a lot of people. Their relationship might be changing as their kids are growing up and leaving the house. Maybe the kind of their role as a mom or their role at work is shifting. They might have aging patient parents, excuse me. And when I was in medical school, we learned that that was really the cause of menopausal symptoms. And we don’t think that anymore.

Betty Wang 00:41:27 But what it that that aging parents made you menopausal.

Dr. Sonia Novotny 00:41:31 It just like lifestyle, you know, like change.

Betty Wang 00:41:35 Oh interesting.

Dr. Sonia Novotny 00:41:36 Life status is a huge part of menopause.

Betty Wang 00:41:39 Oh that’s interesting.

Dr. Sonia Novotny 00:41:41 Yeah. And so that’s that’s definitely something to acknowledge. But certainly also just the actual hormone changes themselves can be a huge part of mood change.

Dr. Sonia Novotny 00:41:51 And the fact that a lot of people have fragmented sleep. I know that when I don’t sleep, I have a very different mood. So I think that there’s a lot of like physiologic things, not just circumstances that are contributing to these mood changes. So if someone says that that’s like their overriding symptom, not really as many hot flushes, but it’s really like irritability and mood changes because I meet a lot of people who say, like, that’s the main symptom that they’re struggling with. This class of medications makes a lot of sense for them.

Betty Wang 00:42:20 Yeah. There are times when I have a murderous rage for no reason. It is interesting because I have some friends who are going through perimenopause, and they also have a young teen girl who are just entering, right, with all the hormone fluctuations. And you and I both have boys, so we don’t notice that. But, you know, I think about growing up with in my teens, with my mom, right. Like, we’re both just we fought a lot.

Betty Wang 00:42:49 And it’s, you know, like the perfect storm with the two different hormone cycles.

Dr. Sonia Novotny 00:42:55 Yeah. Yeah. And we have, like, so much thought in our society about the hormone changes of like, the teen years. You know, and I think we’re just starting to think about all these hormone journeys of the menopause years.

Betty Wang 00:43:07 Yeah.

Dr. Sonia Novotny 00:43:07 It’s also worth saying that outside of hormone replacement, there’s like a newer class of medications. I just want to make sure I, I wrote it down so I could make sure I conveyed it properly. Neuro kind B antagonists. So the most common one is villosa or azalea. And this is a medication that really works at the level of the kind of temperature sensor in the brain. So it treats hot flushes that way. Yeah. So it’s not hormonal. And as a Kaiser physician, it is not covered through our formulary. So it’s very expensive. But I have had some patients who can’t have hormones. They have breast cancer or strong family history. And nothing is, you know, treating these hot flushes that they’re just debilitating, preventing people from getting through their day and doing their job and they need some, you know, something more.

Dr. Sonia Novotny 00:43:56 So this is another option. And it’s a really exciting kind of class of medications that’s just working at a different in a different way.

Betty Wang 00:44:03 Wow. That’s amazing what medicine finds. Yeah. And can you talk about the pellet. Because I know there’s I have some friends who have gone on that and they love it or they hate it. Is that hormone replacement treatment? Like, what exactly is it? And do you recommend it?

Dr. Sonia Novotny 00:44:22 Yeah. So pellets are hormone replacement. They can have estrogen. Sometimes they have testosterone. They are not FDA approved. And I don’t do them as part of my practice. But I offer so many types of other hormone replacement strategies. And so sometimes I feel like people often are kind of going pellets are never going to be covered by insurance at this moment because they’re not FDA approved. So a lot of people are paying a lot of money for these things, and I, I get it, you know? They’re they’re not feeling heard. And I just want to make sure that people know that.

Dr. Sonia Novotny 00:44:58 Myself and other physicians offer lots of other treatments. I don’t offer pellets, but I can offer many bioidentical, FDA approved hormone replacement therapies. I also do some compounded medications. I try to start with the FDA approved medications, which are not compounded. Compounded medications are made and kind of like in batches, you know, for you. So they’re not regulated by the FDA. But there are lots of these like bioidentical that are FDA approved. I don’t necessarily think that things are bioidentical or perfectly safe, and things that are synthetic are dangerous. I think both kind of categories of medication have their place, but traditionally our hormone replacement therapy were synthetic estrogens and so synthetic progestins. But now we have a lot of estradiol, which is bioidentical, and we have a lot of progesterone that are microRNAs, you know, and very similar to what you would make naturally. So I try to offer people those when I offer hormone replacement therapy. Estrogen is the biggest part of it. That’s really what’s going to treat hot flushes.

Dr. Sonia Novotny 00:46:08 You need the progesterone to balance the estrogen because without it, if you have a uterus that puts you at a high risk for uterine cancer to have estrogen without the balance of progesterone, if you’re that person who got their Merina IUD for irregular bleeding, that’s your progesterone. It’s a synthetic, it’s a progestin. But you’ve got that protection for your uterus. And then you can add an estrogen. The best way to get estrogen is transdermal through a patch, because it helps you use the lowest dose that you’re getting in a really nice, even steady state when you take estrogen by mouth. You know, it’s kind of ups and downs, like you swallow it and it gets ingested and metabolized and you have like peaks and troughs of these levels. But when you do it through the skin, you get a more constant, steady state. It’s also not having to go through the liver. So it’s avoiding what we call like first pass metabolism. And the liver is where clotting factors are made. And so we really do think that when you get estrogen through a patch, you have a lesser risk for increasing your risk for having a blood clot in your legs or lungs, because estrogen does increase the risk for that.

Dr. Sonia Novotny 00:47:15 So if you’re a person who’s had a blood clot or a stroke, we really need to talk about other strategies. But yeah, so the patch is a really nice way to go.

Betty Wang 00:47:26 How do you know if someone’s getting enough estrogen then is that then do you test after that or is it mostly if symptoms sort of fade or symptoms alleviated or.

Dr. Sonia Novotny 00:47:39 Yeah, it’s really about your symptoms. Yeah. Yeah. Unfortunately looking at your levels in a blood test doesn’t correlate with your symptoms. And so if a person is in the early stages of perimenopause or early menopause, I use a higher dose than someone who’s been in menopause for a long time of the patch. You’ll definitely meet people who encourage a lot of testing, saliva testing, urine testing. There isn’t strong data for that, and often that is how people make their living is through these lab tests. And so I’ve been lucky that, you know, I tell my patients, like, if you were curious, I am happy to order that for you.

Dr. Sonia Novotny 00:48:18 But I don’t make more money by ordering more tests. But I want you to be satisfied. And if that helps you kind of understand your process, I will order that. But I don’t have a normal gram to say that you’re going to feel great at this serum level of estrogen. The thing that I do test, though, is testosterone, and that’s kind of a tricky conversation.

Betty Wang 00:48:38 I have some people who are say it’s been great, and then other people say it made them. Reiji. I’m like, water. How does that fit into. Is that considered hormone treatment as well? Is just kind of maybe an add on.

Dr. Sonia Novotny 00:48:53 Yeah. Yeah it is. And so a lot of people will notice lower libido around the time of menopause. And it’s a really complicated issue because there’s so many components to that. And so one of the little side plugs that I’d say is if, if this is something you know, that you’re suffering with, like, please make sure that you have time to talk about this because I can’t do this conversation justice, like at the end of your well woman exam as an add on like and sometimes people feel blown off by their providers.

Dr. Sonia Novotny 00:49:22 But this is a big conversation because there’s lots of reasons to have low libido. And it very well can be mostly hormonal. And hormones are certainly going to be a big part of it. But a lot of it could be your relationship with your partner, your communication, the time that you set aside for intimacy, the stress that you have in your life, with your work, with your kids, with your general like mental health status. Because if all of those things are problem, it’s you’re not going to have as much energy to, you know, feel aroused and intimate and to have orgasm. And so you do want to make time for that and optimize all of those things. The other thing to think about is that if people have painful intercourse, that’s a big part of it, too. And treating vaginal dryness or painful intercourse is a lot easier than adding testosterone replacement. I’ll just get into that really quick before we talk about testosterone and libido. But some people tend to not struggle as much with vaginal dryness.

Dr. Sonia Novotny 00:50:22 People who are more regularly sexually active maintain like those healthy, elastic vaginal tissues and have less pain because each active intercourse shunts blood to the vagina and keeps those tissues really healthy. So it’s kind of one of those, like if you haven’t been active in a long time and you’re in menopause, you’re going to feel very differently than someone who’s been more regularly sexually active. Some people can manage their symptoms really well with over-the-counter treatments, and so these things are very worth talking about. The lubricants with intercourse that are silicone based are really good. They’re a lot better than water based lubricants. Unfortunately, the things that are easiest to get at, like a target or a Walgreens or water based, like a gel or even Astro Glide, not all of it is a silicone based. The brand that I recommend the most is good, clean love, or slippery stuff. A lot of pharmacies have this brand now and Amazon has it. You want a lubricant. So that’s, you know, what you’d use with intercourse as a lubricant.

Dr. Sonia Novotny 00:51:22 And what you’d use daily would be a vaginal moisturizer that has a low pH because the vagina should be acidic.

Betty Wang 00:51:30 So some people use a vaginal moisturizer every day. Yeah. Okay. That’s new to me. I, you know, I’m learning. Yeah. Is that something people should do at a certain age or only if they’re asymptomatic.

Dr. Sonia Novotny 00:51:43 If you have symptoms, yeah. If you have vaginal irritation and you’ve come in to see your provider and it’s not a yeast infection or BV and you know, people can get gonorrhea and chlamydia and other infections at all stages of life. And you’ve been ruled out for those things. You do want your provider to look at the tissues of the vagina and make sure it’s not something else. You know, people could have vulvar eczema that only develops later in life, or there’s other skin conditions that could actually be precancerous syndromes or cancer. Those are really rare. But you do want an exam. And if all those things have been ruled out, a lot of people can get benefit from just an over-the-counter vaginal moisturizer.

Dr. Sonia Novotny 00:52:20 So replenish makes a nice one. Good clean love makes a nice one. But the things you’d want to look for is a low pH less than five. So it’s acidic, like the ideal pH of the vagina, because a higher pH can cause like a different balance of bacteria and can make you more prone to yeast or bacterial vaginosis. Bacterial vaginosis or BV is something, you know, it’s our normal bacteria but in the wrong composition and it can be itchy, can have an odor, it can have a discharge. It’s very annoying even though it’s not dangerous. It’s just very frustrating. And so sometimes people do use oils, olive oil or avocado oil, coconut oil. That’s not the right pH. So maybe some people are not as sensitive and that works for them. And if they’re doing that, that is great. But for a lot of people, it could make a more basic pH and could make you more vulnerable to infections. So just to be aware of that. So finding a lubricant or moisturizer that’s acidic a low pH and that has a low osmolality.

Betty Wang 00:53:22 That’s quite the word. Yeah.

Dr. Sonia Novotny 00:53:25 Yeah. It’s not like pulling moisture okay. Something that’s a high osmolality is like pulling moisture away from the cells. If you’ve used these things you might notice like at first they work really well. And then you feel like even worse than when you started. Like the tissues feel even more dry, and it’s kind of like the cycle of having to use more and more and more, because a lot of the more, you know, traditional ones that like, you see first, like at target, they will make you need to use more and more of it because they have a high osmolality. So you want a low pH and a low osmolality. So if someone is, you know, if that’s part of their low libido, is that they have a lot of pain and they associate intercourse with pain. You know, I want to make sure that that’s optimized, because if those over-the-counter things aren’t working, then we go to vaginal estrogens. And this is a super common treatment.

Dr. Sonia Novotny 00:54:16 Vaginal estrogen works really well to make the tissues, you know, more pliable to improve pain with intercourse. Vaginal estrogen can be in the form of a cream. I mostly prescribe esterase, which is a bioidentical form of estradiol. There’s also tablets. The most common brand is called UVA femme that you place in the vagina and by tablet, like they’re the size of your pinkie. They’re kind of big, but you’d put them in at bedtime, and then there’s a ring called the Ring that also has bioidentical estradiol that sits in the vagina for three months at a time. And having that improved elasticity to the tissues, not having pain, having improved blood flow to the vagina, to the clitoris, to all of those structures, for a lot of people that that can be their solution. And they don’t need to do like a systemic treatment that has more risks with it. So it’s worth just making sure that we’ve optimized that. Another thing that’s like newer to me is using vaginal DHEA to treat vaginal dryness. That’s like being recommended more and more by the Menopause Society.

Dr. Sonia Novotny 00:55:22 I’ve just started that in my practice, but there’s good data for that too, so that can be options. The Menopause Society and the American College of OB-GYN recommend that we start with our FDA approved treatments for low libido. First. So first, seeing how people do with adding estrogen because. Estrogen does enter convert to testosterone. So for a lot of people. They feel much better with just adding estrogen. For some people, that’s not going to be enough. We do know that testosterone in and of itself very much does help libido.

Betty Wang 00:55:56 Is that the only thing it helps? Or does it also help the weight gain too? Right.

Dr. Sonia Novotny 00:56:00 I don’t know. I don’t I don’t think that that’s like.

Betty Wang 00:56:03 Oh, I could be making that up.

Dr. Sonia Novotny 00:56:05 It can help you with muscle. And so that would can help with weight gain. I think there’s a lot of kind of touted benefits to that, because the tricky thing is there is no FDA approved form of testosterone. So the people that are offering these therapies may need to really sell it because these are like out of pocket sort of things.

Dr. Sonia Novotny 00:56:25 And so it can probably like all the hormones be associated with everything. We don’t have long term safety data on testosterone. And yet there is no FDA approved version of it in the United States. So it’s kind of tricky. So yeah, it’s pretty rare to see people who really I know people feel that they have low testosterone, and that’s a real way to feel, but who truly, you know, are out of the normal range. Not many people are. But again, you know, like your levels don’t correlate to symptoms. But since I don’t have an FDA approved version of testosterone to offer people, I do for people who really do need it, use compounded testosterone in the form of a trocar, like a little waxy tablet that you absorb under your tongue.

Betty Wang 00:57:07 Oh, interesting.

Dr. Sonia Novotny 00:57:08 Since I don’t have good safety data for that, I try to just keep people in the physiologic range. You know, like the the normal range of a premenopausal woman. And so I do follow those levels like six weeks after starting testosterone therapy.

Dr. Sonia Novotny 00:57:22 And it’s six month intervals for people that are premenopausal. There is an FDA approved treatment for low libido called Addie or flavored band serene, and it is also like in the family of SSRIs, but it has been shown to increase libido. You can’t use this medication. If you’ve had alcohol, you’d have to wait a few hours before using it or not use it that day. And so we just need to be very careful about your liver and that. But but that’s out there. It’s it’s a newer medication and it’s pretty expensive. So it doesn’t suit everybody. But that does exist. But the person should be premenopausal.

Betty Wang 00:57:58 And how do you I know that I’ve kept you a long time. I’m just for people who aren’t. Well, even for your patients. Like what kind of appointments should they make? Because a lot of us are struggle with making appointments, right? Like you have to wait three months to see your provider. I mean, that’s not at all practices, but I would think it’s, you know, within the range of normal.

Betty Wang 00:58:22 Right. Like, what kind of appointments are you making? Because you’re saying that some of these conversations shouldn’t just be at your wellness or your annual visit. Right. So what are you calling to ask for? And how do you know if your current provider like. How do you know if they’re as informed as you are?

Dr. Sonia Novotny 00:58:42 Yeah. And so maybe at your well. Exam to say I really want to talk about this, I know there’s a lot of options. I’d like to schedule another time to talk with you, and then you’ll get to know if your provider feels comfortable having that conversation. Or maybe they’d want to refer you to someone else who does. Or just schedule a menopause consult. I usually get 40 minutes for those visits, and a well exam is just 20 minutes for me. And in that time I’m, you know, trying to do your breast exam, assess your breast cancer risk, because none of us are low risk for breast cancer. All of us are at least moderate risk.

Dr. Sonia Novotny 00:59:15 Doing your pap smear, talking about general wellness, colon cancer screening, bone health, all of those things. And so it’s hard to get a really good conversation. And these conversations are so nuanced. There’s so many options just to make sure that you have the time, because it’s true that not all providers are comfortable talking about menopause. It is not part of a typical residency training. It’s something that someone would want to learn about, usually after their residency. So I would say not everyone is comfortable, but I would say at least in my practice, most of us are and we want to have these conversations. But to feel like you got a good answer, you just want to set aside that time. Yeah. And so to schedule like a menopause consult or at your well exam to to schedule that so you get the best plan for you.

Betty Wang 01:00:01 I know we’ve spent a lot of time on menopause, and I thought we’d have more time for other things, but.

Dr. Sonia Novotny 01:00:07 Lots of things.

Betty Wang 01:00:08 Are there.

Betty Wang 01:00:08 Yeah. Are there other women’s health issues that you see more and more of as that we should be thinking about as we age?

Dr. Sonia Novotny 01:00:16 Yeah. So bladder health is something that I talk to people a lot about, and a lot of people aren’t aware that there is a huge spectrum of options to help with leakage of urine. Having the urge to go. Not being able to hold. You know your bladder. Vaginal estrogen can help a lot of people. There’s a lot of pelvic floor therapy out there that’s really targeted to bladder training. Even just being conscious of your diet, foods that are healthy foods can be bladder irritants, especially for people who have urge incontinence or like when you have that urge to go and you can’t quite hold it. Just looking at your diet and seeing like if there’s caffeine or acidic foods that can help. Like, for example, I don’t drink coffee before I go to yoga because I know I may struggle. I still drink coffee, but I like modify my day. And I know that if I’m about to like, be walking around and working out like I don’t want to drink coffee, so that’s urge incontinence.

Dr. Sonia Novotny 01:01:14 There’s also stress incontinence, like when you cough or laugh or run. And that’s more about muscle changes of the pelvic floor. And everyone has this to some extent. But you know, different people have different core strength and, you know, muscle changes from their delivery. So it’s going to affect everyone differently. But for stress incontinence we can offer a lot of things. So vaginal estrogen can be part of it. Pelvic floor can be part of it. But for this particular problem, something like a PS3 which is a silicone device that sits in the vagina. Yeah. And pushes up on the bladder is something that I that people with. And that can be something that you use just when you exercise there. Some people just use a tampon. There are tampons that are specifically for bladder leakage that have a different shape. The impressive brand poise tampons. I’ve seen them at target, and they kind of have a more square shape, and they push up on the urethra. And so that can be a solution for some people.

Dr. Sonia Novotny 01:02:11 Other people may.

Betty Wang 01:02:12 So this is just aging.

Dr. Sonia Novotny 01:02:14 This is aging.

Betty Wang 01:02:15 Like it could happen like I like in a year or two. This these things, you just kind of notice it or I mean I definitely have friends who after birth they if they sneeze, right? It’s a problem, right? But I bet since I didn’t have that, I kind of thought I was good to go, right? But that’s not the case.

Dr. Sonia Novotny 01:02:34 And you know, you are a really healthy weight, and I bet you’re really diligent with your exercise. And that’s a big deal, because if we are higher weight, there’s just more pressure on the pelvic floor. And if we don’t have good core strength, that also affects us negatively. So like, you know, being the healthiest version of yourself also is a big deal for your bladder. But some people, just as they go through menopause, having the tissue changes of low estrogen could make these problems more noticeable. And so they may want to consider these options.

Dr. Sonia Novotny 01:03:04 And then there’s a lot of surgical treatments too that are very minimally invasive. So like collagen bulking injections at the urethra or a sling procedure I’m lucky since I, you know, would only be doing a handful of these every year. As a general OBGYN, I get to refer to a uro gynecologist. So they’re OB GYNs who’ve done a fellowship in pelvic floor. And my partners who do these do many, many slings every week. They’re really good at it, and that can be a game changer. My mom is always walking around and doing her errands on foot, and I don’t I don’t think she’d mind me saying that, like getting her sling was life changing. You know, she could walk for days. She’s done two Caminos in Spain, where you walk across France and Spain and she’ll do a third. And those things are really hard if you’re, you know, also dealing with urine leakage. So there’s lots of solutions out there. So please know that it’s an everyone thing. Most people you know some people.

Betty Wang 01:03:56 Know that’s good to know.

Dr. Sonia Novotny 01:03:57 Don’t struggle very much.

Betty Wang 01:03:58 Yeah. You don’t want to talk about that right. Yeah.

Dr. Sonia Novotny 01:04:01 But it’s it’s you know, there’s lots and lots of treatment options we can offer people, even people who are like, I know I don’t want surgery, I just had surgery. I don’t want it. But there’s lots of things that we can do.

Betty Wang 01:04:12 Is there a certain age that people start having that surgery or is it kind of wide ranging?

Dr. Sonia Novotny 01:04:17 Yeah. You. So if you want a sling procedure you definitely want to do it after you’re done having your kids. I’m. You know, I’m sort of waiting, you know, for the perfect time for me. But I kind of think, you know, around 50 is a good age because, yeah, something doesn’t last forever. Like, all the gravitational forces that got you there in the first place can can happen again. So you don’t want to do it too soon, but it’s also life changing. You know, people really, really like it.

Dr. Sonia Novotny 01:04:44 So it’ll I’ll probably be there in a few years. I’m waiting to be closer to.

Betty Wang 01:04:48 Oh, no, that’s really I had no idea. So I always closed the podcast with you as a obviously busy and well educated and like, thank you so much for sharing all of your your knowledge. How do you maintain your own personal balance and peace? I mean, we talked a lot about stress today and how that affects things. How do you do that for yourself?

Dr. Sonia Novotny 01:05:10 I wish I knew I don’t. I’m working on it. I’m working on it. I don’t think I’m there at all. Yeah, it’s a busy time, you know, kids are growing up and I’m near my parents and they help me, but I help them, and it’s just a really busy time of life. I definitely don’t have all the answers, so I’ll keep listening to your podcast for more tips.

Betty Wang 01:05:33 Well, I mean, it’s why I it’s why I ask it, right? It’s like I want tips. I want what other people do.

Betty Wang 01:05:40 And then the other question I ask is I have clients who are retiring or who have retired, and I read a lot of studies, and it talks about how hobbies and interests outside of your work can really make all the difference in your retirement. I mean, you can see that with your mom. She’s so busy, she has so many hobbies and yeah, she’s so alive. Do you have hobbies or. And again, this is so that I can steal them. So do you have anything that’s kind of that you love to do when you’re not working?

Dr. Sonia Novotny 01:06:10 I’m trying to get to the gym. I’m trying to do yoga. I’m trying to do my weight bearing exercise. I love to read. I’m in a book club. I love to travel. But my mom is a huge inspiration. She, you know, she was really busy when she was working and I wouldn’t say she was like, perfect at working out and, you know, being perfectly healthy. But as she’s retired, she’s just always moving.

Dr. Sonia Novotny 01:06:30 You know, and she’s just always walking. She’s super engaged with everyone, with our neighbors, with her friends, with my kids. And I think it’s kept her, like really sharp.

Betty Wang 01:06:40 And so socializing is huge. That’s what all the studies say. I mean, and I’m talking about from the financial aspect, if they’re talking about it and, you know, my curriculums, it’s just it’s it means that it’s working. Right. That it’s such an important piece.

Dr. Sonia Novotny 01:06:57 And like, she not only knows the names of all their friends, she knows their allergy. She knows how to drive to their house. She knows, like what Lucas likes. What?

Multiple Speakers 01:07:05 Lucas doesn’t like all this?

Betty Wang 01:07:07 Yeah. Your mom’s amazing. Yeah.

Dr. Sonia Novotny 01:07:08 Because it’s also. You know, one thing I didn’t say is that a lot of people notice cognitive changes around perimenopause, and that’s definitely a thing. Specifically, we know that, like, word recall is harder.

Multiple Speakers 01:07:19 Yeah.

Dr. Sonia Novotny 01:07:20 And, but the things that aren’t impacted so much are just ability to learn and like general cognition.

Dr. Sonia Novotny 01:07:28 But word finding ability is really hard. And that does get better. We think, you know, when you’re solidly in menopause. And I feel like my mom is really like living her best life in menopause.

Betty Wang 01:07:39 Oh my gosh. She’s like my.

Multiple Speakers 01:07:41 She’s working hard.

Dr. Sonia Novotny 01:07:42 At it. You know, she’s retirement hero.

Betty Wang 01:07:44 Yes.

Dr. Sonia Novotny 01:07:45 It’s been about like walking, moving, making new friends, learning new things, trying new things. Really focused on healthy eating. So hopefully I’ll be there one day, but I’m totally not.

Betty Wang 01:07:57 Yeah, it’s life goals for all of us. She should. Yeah, she should actually. Maybe we’ll have her on the podcast is the how to.

Multiple Speakers 01:08:05 Yeah.

Betty Wang 01:08:05 And what’s the best way to find you? I mean, obviously you have to be a patient at Kaiser Permanente to be able to to see you as their doctor.

Multiple Speakers 01:08:13 Yeah.

Dr. Sonia Novotny 01:08:14 So, I’m at the Kaiser Aurora Center Point office.

Betty Wang 01:08:17 Well, thank you so, so much. I feel like I’ve learned a lot.

Multiple Speakers 01:08:21 Thanks for having.

Betty Wang 01:08:22 Me. And we’ll see you soon. Thank you for tuning in to another episode of Betty Smart Friends.

Multiple Speakers 01:08:28 I hope you enjoyed today’s conversation and that you learned something new. You can connect with us on social media to stay updated on future episodes. Share your thoughts, and join our community of smart friends. You can find us on Instagram at Betty Financial. And don’t forget to subscribe to the podcast so you never miss an episode! If you are feeling ready to be more empowered and less alone in your financial life, please schedule a complimentary 15 minutes with me. The link is in the show notes. Please see the show notes for important disclosures regarding BW financial planning and this episode. Until next time, remember you are not alone. We got you.