Episode 16: Mental health in postpartum and menopause

Dr.Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn Podcast. I'm an obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we will talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Hello everyone, and welcome to the Dr. Sophia obgyn podcast. Today we get to speak about mental health, especially since July is national minority mental health awareness month. As always, I am joined by my friend and co-host Touseef Mirza.

Touseef Mirza:
Hi everybody. So, this time we wanted to talk about mental health as it pertains to the minority considering what Sophia just said. And before we get into that, the specific things I like to always get down to basics. Sophia, when we talk about mental health, what are the issues that come up?

Dr.Sophia:
Mental health encompasses, you're right, so many things, right? So, the number one thing we think about when we think of mental health, depression, and anxiety, as the leading mental health issues that women face and basically that people face. But from the obgyn perspective, I think about it from points in a woman's life such as postpartum and menopause, where there are mood changes that women are experiencing that can be influenced by their hormones, and how hormonal changes can affect mental health, including things like depression and anxiety that women can face during those very specific times.

Touseef Mirza:
And so when we talk specifically about minority mental health, are there certain aspects that you can call out that are maybe more affected in the minority community?

Dr.Sophia:
When we consider mental health as an issue? It’s so highly stigmatized and just doesn't get enough exposure. Now add to that, the layer of the minority community, you know, black and brown persons, and specifically black and brown women, where, you know, we are always thought of as being the strong ones and our issues are often neglected in the first place. So, an issue like mental health already is a neglected area of medicine. Now, when we think about the struggles of minority communities and the other things that are influencing them, other than just the chemical imbalances and hormonal issues that can actually be going on in one's body. We have to add the layers of socioeconomic problems, the issues of institutionalized racism, and things that they're experiencing from that level, you know, from a historical perspective, just trauma in general, from their day-to-day existence.

And so adding all those things in, you know, is why it needs to have its own awareness. You know, we need to really call it out and point it out so that way we can start to de-stigmatize it, number one, and no black women are not any stronger, should not have any mental health issues, somehow should be able to just take care of it, so to speak, quote-unquote, no, like everyone else who is suffering, who's in pain, who has a challenge. We all deserve compassion and we all deserve the options of treatment.

Touseef Mirza:
So the way you're talking about it, it seems almost that mental health as it pertains to the minority community, they have a double whammy, which is mental health is already stigmatized, and then you're adding a second layer of the minority aspect.

Dr.Sophia:
Well, the minority experience, right? The black and brown lived experience. Imagine going through something like postpartum depression. When you have that added layer you should be able to just get through it, you should be stronger, you don't have time even to feel depressed because you have to think about how you are paying your bills, putting food on the table and, you know, running your household. Not to say that all women don't have to go through that, but there is definitely, an added layer of complexity when we think about, you know, black women, brown women, and minorities. That's why I'm happy that we're talking about this, that there is, you know, a national exposure for the concept of minority mental health awareness and really to break down those layers is so important because it's what's gonna help women and men go and actually seek help.

Touseef Mirza:
And understand-

Dr.Sophia:
And understand that they're not alone. That they don't have to suffer in silence. And it's why we highlight the things that we do. Here on the Dr. Sophia Obgyn podcast.

Touseef Mirza:
Got that straight. Considering that there are many mental health issues like you named, we're going to focus on two of the main ones that are more focused in your area, that are specifically dealt with from a hormonal perspective, which are-?

Dr.Sophia:
Postpartum depression and the mood changes that can occur during menopause. Okay. I think those are two areas that we need to basically scream from the rooftops that women are experiencing and at, you know, in large numbers. And oftentimes it comes on and they don't even realize what's happening. And so I think the awareness, the understanding that it's a possibility of what could be happening in their body will allow them to feel more empowered to actually seek help and to understand that it is a change actually that's happening within their bodies.

Touseef Mirza:
And then it's not like something is wrong with them or they're, they're freaking out. It's something that is literally happening chemically inside the body.

Dr.Sophia:
Inside their bodies. Yes, exactly. And so that's the reason why I am, you know, happy to talk about it and shed some light on it.

Touseef Mirza:
Okay. So let's start with the first one, postpartum. So just so everybody's on the same understanding, what does postpartum mean?

Dr.Sophia:
So when we think about postpartum and what we're talking about is postpartum depression. It's interesting because most women experience something called the baby blues. Baby blues is very, very common and usually lasts around two, maybe two and a half weeks after the delivery of a baby. It's usually associated with feelings of just feeling overwhelmed, emotional, kind of a little bit out of body, and is very much related to exhaustion, perhaps a reflection of their birth experience, having to now care for a newborn. And, you know, oftentimes, it's a brand new experience. Even women who've had multiple children, can still experience that feeling of overwhelm.

That feeling of, wow, this is what's happening. That moment, again, totally hormonal. You're having major shifts that begin from the moment you enter labor, even in the hormonal process. But that kind of starts to stabilize a little bit around the two to three-week mark. And, for the most part, women have then entered into some kind of a routine and that kind of thing. And then their spirits really lift and they're not necessarily feeling that same sense of anxiety or stress related to this new experience. They really start to get into a groove that feels more normal.

Touseef Mirza:
So you're saying that most women will have the baby blues?

Dr.Sophia:
I will say that a lot of women will experience baby blues, and that baby blues is a very short term timeframe. And I feel like I would call it more of an adjustment period. As opposed to postpartum depression, I would almost very to say it could be like an extension of the baby blues, except that it is with an overwhelming sensation at times of sadness and an overwhelming sensation of an out-of-body experience, and emotions and feelings of being alone, you know, sometimes you're super emotional or the lack thereof.

Touseef Mirza:
Postpartum again, is specifically the time?

Dr.Sophia:
Once we hit a three to four-week mark, post-delivery, and then that persists, and that can be for even up to years.

Touseef Mirza:
Okay. Okay. And then what is actually happening hormonally that might trigger that level of a mental health issue?

Dr.Sophia:
Well, rapid changes, first of all, in hormones, that a woman experiences, there are rapid changes in her estrogen levels, progesterone levels, prolactin levels, and oxytocin. These are all hormones that are working in concert with each other during the pregnancy, labor delivery process. And then when we add the layer of breastfeeding, there are other, you know, ways in which those hormones change. And it's that constant fluctuation sometimes that can bring about some of the mood changes that women experience during the postpartum period. And like I said, it's the extension of those mood changes into weeks on end, including feelings of severe anxiety.

You know, women tend to feel a sense of like, everything can go wrong, something's gonna go wrong. They're very worried, they're very worried sometimes about their newborn. They're very worried about the fact that something must be very wrong whenever the baby cries. It may trigger a big emotional response. And then for other women, they experience a feeling of lack of emotion and connectedness with their newborn. They feel a great deal of shame and guilt for not having that connection, for example, that-

Touseef Mirza:
They thought they would naturally have,

Dr.Sophia:
That they thought they would naturally have, or they feel a big feeling of fatigue just because of their lack of sleep. I mean, let's think about it in the postpartum period. It's like a perfect storm, to be honest. You're exhausted. You are having a lot of lack of sleep. You have hormone changes that are happening in your body. You are expected, though, to take care of not only your newborn, but still figure out how to take care of yourself. And if you're breastfeeding now, we're adding a layer of you are the sole provider of feeding this new neonate, this new baby that you've brought into the world. So it can really all be extremely overwhelming and a feeling of being alone.

Touseef Mirza:
It's so interesting because there are a lot of women, a good population of the women that are having babies, have dreamt about having babies, right? They have been obsessed when we talk about, you know, the clock is ticking and all that. Like they really want to have a baby.

Dr.Sophia:
Absolutely.

Touseef Mirza:
And then they have the baby, and then they have all these other emotions that must be even more confusing because you wanted it so much. And now you're having the complete opposite type of emotions. And even juggling those two extremes is confusing,

Dr.Sophia:
I think more than confusing. I think it's where we get the shame. The shame and the guilty feelings that are really severe at times when it comes to postpartum depression as well as the anxiety, am I gonna be a good mom? Am I a good mom? How can I be feeling this way? And that level of emotional turmoil that is happening outside of things like true depression in the sense of not wanting to get up out of bed or getting to the point where it could even lead to the feeling of suicide.

It could even lead to the feeling of harming not just themselves, but even their newborn because of the lack of connection that they may have. So there are very extreme, you know, cases, but it can happen and if we're not fully aware that these are things that can be happening if we don't even know that it could happen-

Touseef Mirza:
But it's not because you're a bad person.

Dr.Sophia:
That is correct. It's not about you being bad, it's not about you not being a good mother.
And the reality is that there is light at the end of the tunnel. There really is light at the end of the tunnel. And for the most part, women go through it. Okay. You get to the other side.

Touseef Mirza:
How long does it take to get to the other side approximately?

Dr.Sophia:
We first need to recognize it, not just sweep it under the rug, not just say, this is gonna get better on its own. I just need to get a little bit more sleep. Or, if only my husband would understand and maybe take the baby, feeling that I may need some help. And, being okay with that, really having that sense of grace, like I talk about all the time, really having that sense that I think something may be wrong and I may need some help. Feeling empowered and being able to say that and do that.

So that's one, two, anticipating it, especially if you're a woman who may have experienced it before. So now we're talking about this is not your first pregnancy and you may have gone through, an episode of postpartum depression before.

Dr.Sophia:
Now it's really having the sense of self and awareness when it feels like it may be coming on, and who and where to get your support. Not just in terms of as a support team, et cetera, but where to go and what are the things you're gonna say that are gonna be equal, I need help right now. And whether that's with your doctor or setting up a treatment plan even before it happens. And if that's with your significant other, your partner, your husband, your wife, whatever it is, it's the concept of having clear ways to communicate that you are starting to feel low and that you may be experiencing the changes that can happen in postpartum depression.

Touseef Mirza:
You know, I think the, the first thing is obviously education, what we're doing here, like in terms of you're not crazy and you're not a bad person, you're not doing something wrong, but it's something physiologically that it's happening. So that's just what it is. The second thing, I think, is education, and the second thing is self-awareness. Because like, even when we have our periods and then you feel all off and you're just like, what's just wrong with me? I'm so angry today, or I'm so pissed off. And then four days later you get your period and you go, oh. That was PMS and we forget-

Dr.Sophia:
We forget almost every month.

Touseef Mirza:
It's crazy. Like, it's crazy every time it happens, but every time we freaking forget. And so then we say, oh my God, no wonder I was nuts. But I think, and I don't know how to solve it, but it's that self-awareness that, oh, you know, if I'm feeling off, it's not just because I've lost my mind, it's really because something is happening inside.

Dr.Sophia:
That's correct. That's correct. And I love that you use that, PMS-type analogy in the sense that yes, something is definitely happening within your body. And yes, we tend to forget, you know, that's why we are so irritable or have sugar cravings or all the other things that can be happening around the time of PMS, and then boom, your period comes and you feel much better. And the beauty of it, at least when we think about it around our periods, is that it's temporary. It's gonna go away and it's gonna go away on its own. But that is not always the case when it comes to postpartum depression. When it comes to postpartum depression, oftentimes you need help. We need a treatment plan. And I'm not saying that that treatment plan always has to include, let's say, medications, but medications certainly can help.

So just imagine, again, postpartum we are breastfeeding, perhaps And so now it's like, well, I don't wanna take medication. I don't want my baby to get medication. I don't wanna, you know, and that's a whole, again, other layers, you know, to why it can become so severe and why women can let it go for so long. And think that perhaps there's something they could be doing about it in a quote, unquote, more natural way. And, yes, exercise can certainly help with diet changes. Diet changes can certainly help. But unfortunately for a lot of women, that's just not enough. I mean, we're talking, there are women who have the best of support, whether they have someone who can come and cook for them, their in-laws, their siblings, their, you know, friends, and yet still they can be experiencing postpartum depression.

Touseef Mirza:
Is there anything that you can do, like before you deliver your child from a preventative standpoint, is there anything like to, you know, curve that flyball?

Dr.Sophia:
You know what's interesting? I actually just saw a woman who is a client of mine, and it was so interesting. She definitely had a severe episode of postpartum depression, with her first child. And so everybody, her, her husband, her family, everybody was on guard. Everybody was on notice. And she herself was just prepared for the possibility that she could experience postpartum depression with her second child who came about two years later. And one thing I felt that she did that was incredible was she was almost chanting to herself. She basically was like, I'm gonna be fine.

I feel well, I feel good. I am happy that I'm pregnant. I am happy to be going through this process. I am happy about this delivery. And after she delivered, and luckily she had a beautiful delivery. It was very, atraumatic, which was a little bit different from her first delivery, but afterward, she just kept reaffirming the good feelings that she was feeling. And she said that it felt like it, that better prepared her the second time around. And that she actually made it. She did have a few times where she felt that feeling of overwhelmedness, that feeling of a little stressed out in those first two or three weeks. But she said it just didn't last.

Touseef Mirza:
She was self-aware.

Dr.Sophia:
Right. But she was super self-aware. She was super self-aware. She was paying attention to every single feeling and emotion and she, like I said, literally was like meditating and chanting and, and just really doing a lot of, affirmations. I'm not saying that that is the end all be all of prevention. I think that women who may already have some tendency for depression, for example, pre-pregnancy, then they may need to consider being on an antidepressant even throughout the pregnancy or immediately after delivery. I think we need to embrace that and understand that as a function of their self-care.

Touseef Mirza:
I mean, I think even more broadly from an antidepressant perspective, it's starting to become more normalized in terms of its usage. Because usually, we associate that if you take drugs like antidepressants for your mental health before it was, well, it means you're not strong enough to handle it, by yourself. You know, like you failed somehow.

Dr.Sophia:
Right. And having to take an antidepressant during an episode of depression does not make you a failure. If anything, it makes you a winner. It makes you someone who has overcome and won this battle because you're willing to challenge it and take it by its reins.

Touseef Mirza:
And also self-worth. Right. It means that I don't have to go through this, this way. There's another way to do it.

Dr.Sophia:
There's another way to do it. I value myself. I value my health. I value my mental health. I wanna be healthy and strong in that.

Touseef Mirza:
How long does postpartum depression typically stay after delivery?

Dr.Sophia:
It can be years. If it's not treated, it can then change from just being what we call postpartum depression to severe depression that started out as postpartum depression.

Touseef Mirza:
So it can be sort of like a trigger, an instigator for-

Dr.Sophia:
A more long-term process. Yes, of course.

Touseef Mirza:
I did not know that. Okay. In terms of the women that come, black and brown women that are dealing with postpartum depression, have you noticed that there is something more specific to them in terms of their experience or their approach, or how they feel about postpartum depression? Do they bring it up more readily or less readily to you?

Dr.Sophia:
I take the approach of talking about everything with my patients, and that includes preemptively talking about postpartum depression during their prenatal care course. So that way there's no, there's no surprise. If we know that it can happen, then we have a better chance of actually talking about it. So basically, by letting them know this is a possibility. If this, if you start to feel these symptoms, and I want you to reach out if you start to feel these, you know, anxious feelings or these episodes of severe sadness, I don't want you to wait to see me at the four to six-week mark postpartum. I want you to come in and see me sooner. And that's okay.

Touseef Mirza:
So you're already giving them permission before it hits.

Dr.Sophia:
That is correct. Absolutely.

Touseef Mirza:
That's so important

Dr.Sophia:
And the permission needs to come from them.

Touseef Mirza:
So now let's switch to menopause. I think, what we just talked about more from a relational standpoint of looking at mental health, there are similarities in terms of what we talked about in postpartum depression in terms of, you know, how you show up in self-awareness. However there are specific differences of menopause because it is a different animal. So just starting from the ground up, what is the definition of menopause?

Dr.Sophia:
Well, menopause itself is a hormonal change that happens where you have the cessation or you stop having a period, for a consistent 12 months. But the changes that are happening hormonally can be that you can experience those things up to 10 years before you actually stop getting your period. Or even you start to experience changes happening with your period. Those hormonal changes include shifts in estrogen, shifts in progesterone, shifts in thyroid hormone shifts in testosterone, all of the things that actually can affect your brain and your mood. So if those things are happening, and you know, they start off slow.

Touseef Mirza:
Also, the average age of menopause is around 51.

Dr.Sophia:
That is correct. The average age of menopause is around 51 in the United States. But like I said, we start experiencing the symptoms of menopause 10 years before.

Touseef Mirza:
Before. So that's like in your early forties, you can start having-

Dr.Sophia:
That is correct. Even in your thirties, you can start experiencing some of these changes because normal menopause can happen at someone who's 40. So if the earliest time that you can experience normal menopause is 40, then imagine you can start experiencing menopausal symptoms at 30.

Touseef Mirza:
So when we talk about hormonal changes as it pertains to menopause that affect mental health, what does that look like?

Dr.Sophia:
Oh boy. That is opening up a box. But let's talk about it. It includes irritability, it includes new onset anxiety, paranoia, and just a sense of worriedness. It includes depression, feelings of sadness, just emotional lability. You're going from one emotion extreme to the next. It just feels like you're up and then you're down, and then you're sideways. You know, it includes things like brain fog or just like changes in your ability to focus it. It could be the first time a woman has a sense of things like ADHD for example. She's like, why the heck can't I focus on anything? Or why am I having problems learning something? Or why am I having challenges just to speak?

Touseef Mirza:
Listen, I just finished my one year. I'm like officially in menopause now. I haven't had a period in over one year, and I'm a pretty sharp thinker. And this past week, literally, I was just like, why can't I think?

I am a sharp cookie. And I was just like, okay, maybe I need to sleep. Okay, maybe I need to go for a walk. And so I do all those things but it's still there. It's still there. I feel pretty sharp. So I think, the hump is over but it just comes out of left field. And I never experienced that in PMS. Like I didn't, I don't, I'm not a brain fog girl. That's just not my jam. So when it happens, it's just bewildering. It's just like, what this is, am I losing my mind?

Dr.Sophia:
That is exactly how women in menopause and perimenopause feel. It's like, am I losing my mind?

Touseef Mirza:
Like literally losing it is, has it left the building? Yeah. Have the cells left my brain, like, am I gonna get them back? And then when I get sharp again, I'm like, hallelujah. Everything's gonna be okay.

Dr.Sophia:
And let me tell you, for some women that hallelujah moment doesn't necessarily happen. It doesn't necessarily come back. Just imagine being in that constant spiral of that and, and then feeling, like I said, this out-of-body experience. And imagine it's usually a time in your life when you're at the top of your game. Most women are well into their careers or they feel more-

Touseef Mirza:
Confident.

Dr.Sophia:
Confident because they've accomplished so many things in their lives, so to speak. And then now all of a sudden, every little thing is getting on their nerves. They are not able to even have connections with people the way that they used to. They're not able to have a connection and intimacy, let's say, with their partners. And they're not sleeping. So what are some of the things that they do share with women who have gone through postpartum for example? Sleep disturbances, you know, exhaustion, fatigue, and the ups and downs of their hormones. So that, I would say, is probably the hallmark.

Now, of course, just like with postpartum depression in menopause and perimenopause, if you were a woman who had any previous diagnosis of a mental health issue, that can be stressed or exacerbated during those times. And so it's important to recognize that that can happen. And, and it's important to understand that in general, mood changes can happen during perimenopause and menopause. It's not your fault. You're not all of a sudden becoming this evil person. There are real changes happening in your body that you don't necessarily have control over, or that you have to make actual changes to help combat it.

Touseef Mirza:
So when we talk about the changes, are we talking about changes that are more lifestyle or treatments?

Dr.Sophia:
Absolutely. I mean, lifestyle changes, I always advocate for lifestyle changes. It's a time in our lives when if we weren't exercising, if we were just sitting like a bump on a log our whole lives, we were figuring it out. Just kind of like coasting without ever lifting a finger. This is not the time. This is definitely not the time. This is the time in your life that you wanna feel your strongest. You wanna really hit the gym, you wanna be lifting. You want to add those stressors to your muscles and warm them up. Because in doing that, you have an opportunity to have that beautiful dopamine release that is gonna really help to combat some of the mood changes that are happening during the time of perimenopause and menopause. Outside of that, though, we have to realize that estrogen plays such a huge role on the brain, a huge role.

It's actually a part of that dopamine release. The drop in estrogen is associated with so many things, the hot flashes and the anxiety that provoke the sleep disturbances and the exhaustion that that provokes, and how that all affects how we feel. I'm not saying that just let's say, oh, let's just do hormone replacement and I'm gonna have, I'm, all of my mental health issues at the time may go away, but you know what? It might, and in all honesty, it might be a part of the program.

So we're gonna make diet changes, we're gonna do exercise, we're going to consider hormone replacement therapy. And if we have to, we have to consider some form of anti-anxiety or antidepressant. But it's a combination. It's not only one end all be all, but if we don't even know that it exists, if we don't even know that it's happening, you know, these hormonal changes that can lead to these other things, then we're not gonna be able to address it fully.

Touseef Mirza:
In terms of the medication. Is it just estrogen? Or you need to actually get evaluated to figure out what is the hormonal balance that you have and be given different hormones in accordance with that.

Dr.Sophia:
A lot of different hormones affect your mood and it can affect your mental health. I think that is definitely an individualized conversation with your physician. However, definitely estrogen plays a major role, and it's unfortunate, but testosterone also plays a role. The thyroid also plays a role and the concept of optimizing your thyroid, it's unfortunate that we just think about, oh we treat this one number, and if it looks like it's in the normal range, well then you're fine.

But I'd rather be on the higher side of normal than on the lower side of normal because the lower side of normal might be abnormal for me and might be what's making me feel completely unfocused, you know, or have more severe mental fog, et cetera. You know, if we're just talking about thyroid hormone as an example, and certainly replacing estrogen at a time when you are going through perimenopause and menopause can really normalize.

It puts you back in that even place. It puts you back basically where you were before you started experiencing all these ups and downs in your hormones. And there's nothing wrong with that. All that's gonna do is add longevity to your life and how you feel in your life and the sense of vitality in your life. Hopefully take away some of those mental health challenges and issues. And I'm not just saying that in a vacuum. Right. I'm not saying, oh, okay, this is gonna be the only answer. Like I said, we have to change the way that we eat, you wanna eat foods that are not gonna be inciting inflammation in your body, for example.

Touseef Mirza:
Reduce them.

Dr.Sophia:
Certainly reduce them if we can. Yes. We want to exercise. And it's not just, well, let me la di da, you know, go for a walk. Although walking is very important and does a lot of other things for mental health. Right. But it's the lifting weights and really becoming stronger and adding those stressors to your muscles, that is going to help combat some of the issues and the things that are happening with you during, you know, that perimenopause, menopause transition.

Touseef Mirza:
I also think it's important to point out that when we have mental health issues when it comes to menopause and perimenopause, that the solution straight is not antidepressants. Because there's such a huge connection between depression or mental health issues with antidepressant medication, but this is actually a whole different strategy because we're actually addressing the source of the problem.

Dr.Sophia:
Yeah you need to be going to the root cause. If you're taking a woman who's never experienced anxiety before in her life, and now all of a sudden in the last six months she's anxious and thinking about everything, then we have to take into account that, that anxiety, and she is now let's say 47 years old, maybe due to her hormones.

And let's see if there's a way that we can somehow balance that or add back what she's currently losing and how that may change her sense of self, that sense of anxiety, those panic attacks, the things that are happening to her that she's like, I've never experienced this before. That sense of emotional lability, like that woman who's like a solid as a rock, has never cried, you know, and then now all of a sudden, every time you speak to her, she's like, oh my God, my life is over. That woman might need hormones.

Touseef Mirza:
That woman. You know, as we're talking through all these different aspects, I think as women and especially as black and brown women, I think one thing that's really important to share is that we are allowed to feel good.

Dr.Sophia:
Ooh. We are definitely allowed to feel good, and we should.

Touseef Mirza:
Because maybe certain people, when we think about mental health and being moody and all that, that's like, oh, you know, that's small beans. Like, you know just put it under the rug. This is not like, you know, cancer or something like that. You know? So we should be able to deal with it. Meanwhile, we should be able to have the best life that we want. And I think that's part of the problem of not looking at these things. If we do have solutions that can help us, we are allowed to feel good.

Dr.Sophia:
I love that you bring up that point. I think it's a part of the stigma. It's a part of the problem of, wow, why can't you just deal with it? You know, this is a natural quote-unquote process. Just deal with it. And I think it's very important for us to recognize we are living longer and we're living longer in a timeframe called menopause. Why not live longer, healthier, happier, joyfully, stronger?

If that means that in order to achieve that, we need to either have hormone replacement or a combination of therapies, there's nothing wrong with that. We should be embracing the fact that we recognize that for ourselves, that we want that for ourselves, and that we're working towards that. That there is nothing to be ashamed about because you want joy and you wanna feel good in your body

Touseef Mirza:
And you matter. Every single, every single woman, every single person matters. And sometimes I think we forget about that, and we're just going through the motions of just going day by day, but actually stopping saying, no, you know, I wanna feel, I wanna feel good, and we're allowed to have that for us.

Dr.Sophia:
Absolutely.

Touseef Mirza:
And then the second thing, I think, from a black and brown woman perspective, since these two areas are stigmatized, I think it's really important to have more open discourses. Like, you know, we're having this discourse right now. Right. But having a talk about it with your girlfriends, you know, having a talk with your family, even if it feels a little odd at the beginning, but it's okay to be that icebreaker and say, you know what, can I just run something by you? Like, you know, how did you feel? I'm feeling this way. You know? And just, I think we just keep it too much-

Dr.Sophia:
To ourselves?

Touseef Mirza:
To ourselves, because it's so stigmatized.

Dr.Sophia:
Well, the part of keeping it to ourselves is sometimes just a part of the shame, the guilt, the unknowing. When we're talking about menopause, especially, it's the unknowing, it's the same time when, you know, when a woman first misses her period, she's like, what the heck is happening? Am I pregnant? That's the only thing that could possibly be happening. And they're very nervous and scared and, you know, perhaps they haven't had that conversation with their moms, their aunties, their grandparents, about what it was like to go through that menopausal change. Or they haven't had a conversation with their obgyn or their primary care physician about the fact that they may be approaching a time in their lives where they're gonna be going through a transition. And I think it's very important for us to have those open discussions.

Dr.Sophia:
And even if it just starts with our intimate circle, it's the reason why having sisters, girlfriends, your tribe, your people, the ones that you know, will love and support you no matter what. That should be the place where you feel comfortable saying, Hey, I'm really going through something. I feel like I just started having all of this anxiety all of a sudden. Has anyone else experienced that? Has anyone else felt this way? Or just to say things like I think I missed my period and I don't know, in my menopause, you know, when you bring that up with your doctor, and I think it's fair to say, I'm having a challenge and is anybody else having it?

Because that way you don't feel alone. You'll realize that yes, there are a lot of people having it around you, all of your girlfriends if you are a woman of a certain age, they are all, we are all in it together. We're all experiencing it and yet not talking about it right now. Literally right now, we're so lucky in the sense that there is some highlight of women going through menopause. And I think it's because so many of the icons in our society in terms of famous people who are currently going through menopause, and you know, that perimenopause transition are bringing some-

Touseef Mirza:
Including myself.

Dr.Sophia:
That is bringing some awareness to the challenges that women face during this time. And so we're fortunate that women are talking about it. But like back in the day, nobody talked about it. I don't ever remember Elizabeth Taylor talking about menopause and what she may have gone through, but at least now we can talk about it. There is some light being shed on it. I think understanding that there is a mental health aspect to the change in your body that's happening in the time of menopause is so important.

At least just that little piece of knowledge may help a woman go to her provider and say, I think I'm experiencing this. Can we talk about it? Can we talk about what some of the solutions might be? What are some of the ways I can help myself combat this? And if I have to, are there treatment plans that we can talk about?

Touseef Mirza:
I would say also when they recognize that it's important to be gentle with themselves.

Dr.Sophia:
Every single time, because-

Touseef Mirza:
I think we forget about that too. You know, when something is sort of like, put on us, we think it's our fault. And instead to take a pause and say, okay, you know let's not get angry at myself for something that I have zero control over.

Dr.Sophia:
We always have to have some grace with ourselves. We have to embrace our body for what it is and what's going on with it. And then we can therefore work with our bodies to try to help ourselves feel better, feel good, and get over to the other side.

So, in closing, I would like to share a little excerpt from a poem that I found written by a woman, Lisa Marks. And it's called Just Wait for the Sun. When everything's darkness and when you feel so alone when the rain doesn't stop and you can't make it home, when it feel all is lost and you just want to run, it can't rain forever. Just wait for the sun. When family is pain, when friends can't be found, when you just wanna scream, but you can't find the sound when it's all your fault and you feel like you're all done, just wait for the sun. The sunshine will come. Thank you for joining us on the Doctor Sophia obgyn podcast. Until next time. See you later.

Touseef Mirza:
Bye.

Dr.Sophia:
This is General Medical Information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.