Episode 41: Period changes during perimenopause in your 30s and 40s

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 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. As always, I'm super excited to talk to you about a topic that I feel like we're just not talking enough about, which are changes that can happen with your periods during your thirties and forties leading up to menopause. Part of the reason why this became even a topic or something I wanted to mention is because I have patients all the time who are experiencing changes in their periods and I figured if they're asking questions and they're having issues, then many of us must be having issues including all of you outside in the world. So without further ado, I always have my lucky, wonderful cohost, my good friend, Touseef Mirza.

Touseef Mirza:
Well, I also have a very lucky friend. This is Dr. Sophia. So, so yeah. So we were talking about periods. I mean, I'm at a point, I'm 53, I don't have periods anymore. Well, actually, we'll talk about my HRT at another time where there were some surprises here and there that happened. But we'll talk about it later. But we started to think about how usually in our twenties we're pretty regular.

Dr.Sophia:
Definitely.

Touseef Mirza:
And we're expecting it and it becomes routine and we just know what's gonna happen.

Dr.Sophia:
For sure. Your period is like a part of you. You know, like for a lot of us, it was like clockwork.

Touseef Mirza:
Yeah. And then all of a sudden, I guess it's not everybody and it's not in the same ages, but a lot of us when we are in our thirties or forties, start to see certain changes that happen. And some of them might be minor and we just say, oh, you know, come si, come ca, happens once. But some of them can be more drastic.

Dr.Sophia:
Things change for a lot of women in their thirties and forties and sometimes it's very subtle. Like you're saying, maybe their period used to be every 30 days like clockwork, and now it varies. It's a little bit more like between 27 to 29 days. And that's just the beginning of a bigger change that may be happening. And other women, it could be that they have a period used to be like five days and now all of a sudden their period is seven days or it was just a little light flow and then now it's a little heavier flow. The bottom line is, things definitely change in this timeframe. And sometimes those changes can be so dramatic though that it makes women feel like, oh my God, something is definitely wrong, for sure something is wrong.

Touseef Mirza:
Something's changed.

Dr.Sophia:
There is a change that has happened that should be evaluated. A change in your period should prompt you to wanna talk to your provider, whether that's your primary care as your first line, or of course your obgyn or your woman's health provider. But it should prompt you to see someone.

Touseef Mirza:
But that, you know, it's interesting you're saying that because if for example, I was usually 28 days and now I'm all of a sudden at 30 days, for me, I'm just like, awesome. Like it's coming in later, so I'm not even gonna bother with that. Or if I used to have a certain flow with my period and now it's less. And even if it's a change, it's a change that I welcome. So I wouldn't really bother about it. But if all of a sudden the flow is twice as much and now instead of every 30 days it's coming every 20 days, then I might start panicking. So I think also the changes warrant something different; the people have different reactions to that.

Dr.Sophia:
No, for sure. And you know, like I'm saying, like a change that's happening, let's say you used to be 27 days and now you're 30 days. Maybe that's not the kind of change I'm talking about. That requires you to necessarily need to come in and see a doctor because a normal period, the cycle can be as short as every 21 days or as long as every 35 days. And so if you fall in between there, then the likelihood is that you're probably somewhere normal. The thing is, our bodies are creatures of habit and so you're not like, it's not gonna be normal if you're this month, you're 35 days between period to period and then all of a sudden next month you're 21 days from period to period. No, that's a big change. Even though it falls within normal, it's still not normal.

But maybe going from, you know, having a period, because it can fluctuate just by a few days. Most women have their period that fluctuates. You know, it can be every 28 to 30 days, for example, it could be every 24 to 26, like that kind of thing. But if we're talking about dramatic changes off by more than a week, then yeah, that's a change that requires I think at least a visit to a provider to discuss. And that's just what we're talking about, cycle length from one period to the next. But you mentioned the concept of heavier bleeding. So why are we even having this conversation is because I want to be able to normalize the conversation around periods in that we should be having them. That's one. And also the concept of how period changes can actually be linked more to perimenopause, which is something most women in their thirties for sure are not thinking about. And even women in their early forties are still not thinking about that. There could be changes happening with their periods that's related to perimenopause, when in fact that could actually be what's happening.

Touseef Mirza:
So let's define what perimenopause is.

Dr.Sophia:
Perimenopause is that transition time leading up to menopause. Perimenopause can have changes in periods and menopausal like symptoms that women would typically think of, oh, that only happens after menopause, but can happen during the transitional time, such as night sweats, hot flashes, changes in energy, mood changes, mental health changes, body changes, weight gain, insomnia, and sleep disturbances. Just such a plethora of changes that can happen before you actually get to menopause.

Touseef Mirza:
Because a lot of people think that those symptoms that you just named are triggered after menopause, which is actually false.

Dr.Sophia:
100% false. Not only are they not triggered after menopause, they're triggered up to 10 and even as early as 15 years before menopause, you actually go through menopause. And don't get me wrong, 15 years is not the norm necessarily, but it can happen. A woman can be experiencing perimenopause at 35 in her thirties if she goes through menopause in her late forties, you know, which-

Touseef Mirza:
Is not abnormal. 35 to 40 to have perimenopausal symptoms.

Dr.Sophia:
No, no it's not. And that can include period changes.

Touseef Mirza:
So when patients come and see you specifically, like women that are in their thirties or forties, and they're really concerned about changes in their period, what are the symptoms that they mostly talk about?

Dr.Sophia:
Well, I'll tell you. I mean, the amount of times that women come in because they're having a heavier period, I think that's a good one. Not necessarily as some kind of hallmark, but they come in and they say, you know, I don't know what's happening the last three periods, my period has become significantly heavier. So instead of using the average, which is about maybe four maximum like six pads in a day, in a normal period, they're now going through like 18 pads, you know, like in two days.

Touseef Mirza:
That's scary.

Dr.Sophia:
Exactly. And fully soaked. This is not like, oh, I just, every time I go to the bathroom, I feel like I want to change. No, this is, I have to change my pad because I have soaked through my pad.

Touseef Mirza:
Because I don't have a choice.

Dr.Sophia:
Because I don't have a choice. It's coming down like a faucet. And so of course the rest of their body starts to catch up with the fact that they're bleeding so much. And so they're feeling more fatigued and they may be experiencing signs and symptoms of anemia, and that's a reason that brings them in because they're like, I'm just so tired, I don't know what's going on. And my periods have gotten so heavy.

Touseef Mirza:
So would you say that some of your patients, because the period is heavy, they get scared and concerned and come and come and see you and or sometimes it's not, they just say, oh, my period is just a little more now, but it's really because of the effects that they come and see you, for example. Anemia.

Dr.Sophia:
I think it's a combination, honestly. I think for sure when women see heavy bleeding, I'm glad that it usually will trigger them, but trigger them when I say to come in to be evaluated. But oftentimes they may call a provider or call a provider's office and say, I think my periods are a little bit heavier. And, they may be dismissed because if it's coming when it's supposed to, it's lasting the number of days that it normally does. Sometimes it's like maybe they're just exaggerating, which is definitely not the case. It's a change that's really happening. And the reason why I say it should be evaluated or investigated is that there's more than just hormonal changes that can be happening. We wanna rule out other causes of why you could be having heavy bleeding and you could have something called fibroids that are in a location in your uterus that's causing the heavy bleeding.

Dr.Sophia:
You may be experiencing the heavy bleeding because you have a problem, not even with your uterus per se, but what if it's your cervix that's having the problem? What if you have something called a polyp, which could be either at the level of the cervix or inside the uterus itself. So there's so many other ways, and that bleeding can happen that when it is heavy, it should be like a ding, ding, ding, ding, ding, what's happening here? The thing is, some women have heavier periods and they've had them like that for all of their lives. And so they don't even notice that it's become like a crime scene. You know, and I can attest to this, I really can, because of the fact that I was someone who had a very heavy period when I was younger, I had a very, very heavy period. So like regularly,

Dr.Sophia:
Like every month, I just felt like this is crazy. And for me though, I felt like it was very heavy, I guess because of my lifestyle. I never really showed signs of anemia, for example. Like, it didn't slow me down. I still lived my life. I still did all of my activities, et cetera, but I was that girl who was going through more than six pads in a day. And so I can understand how a woman who has a period who, you know, even starting in her younger years, has a heavier period, and then now it just changes and becomes even a little bit heavier in her thirties is like, oh, well this is just who I am. And then doesn't even make the connection that something could be different or it could be wrong or needs to be evaluated.

Touseef Mirza:
You know, you bring up a good point, because I've had fluctuations in my period in my thirties and forties. For me, it wasn't, I had once that was really heavy bleeding, but aside from that, most of the time in my thirties and forties I just started to have a lesser flow. And the time in which I had my period, which before was like six days, went down to more like four or five days. And I was happy about it. I was like, okay, well, that, that's just what it is. But honestly, I never thought to ever bring that up or think that's something, it's something that I should talk about. Like, I just thought, okay, that's just how periods evolve. You know? Like there was nothing that was alarmist in me or ever thought that it's something that I would, that I would bring up. And that, and that one time where there was so much blood that came out of it, and I'm not, and I'm not a queasy person. Like, I can look at blood, and I'm okay, but it kind of freaked me out. And that was the time I called you, losing my mind. And I was like, oh my God, am I gonna die? What's gonna happen to me? But it's just very rare, aside from I guess what I'm trying to say, unless for me, if it's not traumatic, everything else is just part of the period. Like, I never think about, oh, maybe I, maybe there's something to talk about because I just think it, it's just gonna do what's gonna do and it, you know, it's not a big deal.

Dr.Sophia:
Right. And I guess what I'm trying to highlight here is that it's important to talk about your period, because your period can signal something else that's going on. So even if, yeah, for you, in your case, your period went from being let's say six days to four days or three days even, right? Well, that might have been a small, that at least could have been an opportunity to talk about the fact that hey, you're in your forties, you know, if you're having changes in your period, whether it's because, because they're coming heavier, lasting longer, shorter intervals, longer intervals, whatever it is, this may be a signal that your body is going through the transition time that we call perimenopause.

Touseef Mirza:
Well, I did not have you as my obgyn, and nobody brought up perimenopause. And I think maybe that obgyn said, oh, so is everything okay with your period? And I'd be like, yeah, because for me that wasn't really a problem to talk about? And so, you know, I would just go for my pap smear, everything's fine, bye. And then I would see her a year later, like for me talking to the obgyn had to be like something that was almost extremely serious, or else I would just keep it under wraps.

Dr.Sophia:
So this is why we have this podcast.

Touseef Mirza:
That is true. I wish I had this podcast.

Dr.Sophia:
This is why so many women just assume things are okay or normal, or don't remember to bring it up in their, you know, 15-minute time slot that they have with their doctor, or they forget they have a list, you know? And period is not gonna be the number one on that list necessarily, but your period can be the first clue or unscheduled bleeding. The fact is, any bleeding that is not your normal bleeding, let me just put it that way.

Touseef Mirza:
Let's say it again.

Dr.Sophia:
Any bleeding that is not your normal bleeding should be addressed. Because yes, right now we're talking about the concept of perimenopause changes. And I'm gonna go into a little bit more detail. Perimenopause changes with your period. Like I said, your period can become heavier, lighter, shorter, longer. Women can have changes in their cycle length. A woman who was normally 27 to 29 days, days, now all of a sudden her period's coming every 18 days. And she's like, what the heck? I have a period every 18 days and my period lasts for five days, so I only have four days in the month when I have no period. Like what's happening here? So it can be very nerve wracking. These are the changes that can happen in the period due to perimenopause, because perimenopause is a constant fluctuation of your hormones, estrogen, progesterone, always up, down, sideways, which then leads to a sideways type of period.

However, there are other things too that can cause crazy bleeding. That's actually not your period. Could it be that you have fibroids that are undiagnosed and only now they've grown to a critical size, or they're in a location that affects your period? Could it be that you have a polyp, whether that polyp is inside your uterus or not? Meaning inside the uterus or at the cervix. Do you have bleeding after sex? Could you potentially have cancer, meaning abnormal cells at the level of the vagina, the cervix, or the uterus that's causing you to have weird bleeding? The only way for us to know is if you bring it up and if you come in to get it addressed. So that's why it's so important that we talk about it.

Touseef Mirza:
So I think there's that part obviously in terms of making sure that a woman is healthy by looking at what's happening in terms of her periods. And the other part is for women, since we're talking specifically about women in their thirties and forties here, for women in their thirties who wanna get pregnant, like for them, that's another big question, right? It's like, okay, so how can I plan this if my period's all over the place? When is the optimal time for ovulation? And they don't know when that's gonna happen. So I'm sure that can also be aggravating as well. And they're trying to wonder how it is affecting my ovulation?

Dr.Sophia:
That is a perfect question to ask because if your period is off, your ovulation is off, then you have no idea when is a good time to actually plan a pregnancy. For example, our periods definitely help us to know when is the best time to have sex, when not to have sex, you know what I mean? Like, depending on what your heart's desire is. And so when you're in your thirties, this is the time to have a really concrete discussion regarding your fertility and to understand what's going on with your period in order to understand, can I have babies? Can I not have babies? Am I fertile? Am I not fertile? These are questions that definitely should be happening around that time. And maybe it's those changes that happen in your period that can trigger that kind of conversation.

Touseef Mirza:
So can you tell us a little bit about one patient that came to see you that we talked about?

Dr.Sophia:
I'm happy you're asking me because I had a 37-year-old patient come to me, and it's such a roundabout kind of way. She came to me actually, because she thought she had a yeast infection. She was complaining of vaginal burning, itching, wasn't sure if she was having much discharge, but because of the itchiness-

Touseef Mirza:
Vaginal discharge?

Dr.Sophia:
Vaginal discharge, that is, she wasn't sure if she was really having much that was considered abnormal per se, but because she was having the itchiness and because she was having some burning associated with it, like at the level of her lips, labia, that is around the vulva. Yes, I know that's your favorite word.

Touseef Mirza:
I like saying vulva.

Dr.Sophia:
But because she was having these symptoms, she associated it with having a yeast infection. So she came in order to be examined. And so, on my exam of her, I realized that she really didn't have much discharge that was consistent, at least with what I would look for in a yeast infection. And moreover, her labia looked more dry and looked more, well, what we were talking about in, you know, before another time when we talked about vulva or vaginal atrophy. And she looked more like that, but she was only 37. So I'm saying to myself, I had to ask her the question. I said, " Well, let me ask you, what are your periods like?”

Touseef Mirza:
What is vaginal atrophy?

Dr.Sophia:
So vaginal atrophy is the loss of elasticity and kind of the thinning of the vaginal tissue related to changes in estrogen. And when I saw that, I said to myself, Hmm, I wonder what else is going on with her? Because whether or not she had a yeast infection, I couldn't 100% say that at the time when I examined her. So I collected a swab in order to check for that. But what I did see was this change that was happening with the tissue of the vulva and the vagina. And that's what led me to ask her other questions.

Touseef Mirza:
So when you say changes in the tissue, in what way?

Dr.Sophia:
It was becoming thinner. Okay. It looked drier and led me to ask her questions regarding other things. I asked her, you know, is sex painful? And she says, well, actually I've not been sexually active. And I said, why? And she says, well, I actually just haven't really had any interest. So her libido had changed. And since she hadn't had recent sex or anything, she really couldn't speak to the fact of whether or not it was painful or not. At the moment. But definitely she could speak to the fact that her interest in sex had changed and she was having this change at the level of the vagina and vulva that was happening. And then that led me to ask her about her period. And she says, well, actually, I am seeing a hematologist because my periods have become so heavy that it's causing me to be anemic. And I was like, wait, what?

Touseef Mirza:
She did not mention any of that before?

Dr.Sophia:
No, she came to me because she was having vaginal itching and burning

Touseef Mirza:
That she thought was associated with the yeast

Dr.Sophia:
Infection, yeast infection, which then turned the whole conversation after.

Touseef Mirza:
Meanwhile she's having ridiculous blood flow that she has to go see a hematologist for.

Dr.Sophia:
That is correct. Meanwhile, back at the ranch, she's going to a hematologist. Exactly. But moreover, it's like this roundabout way of getting to the fact that I wonder if she's having hormonal changes that's actually leading to all of her symptoms that she's having. Right. This could be really, all of her symptoms can be explained just by understanding perimenopause, hormonal changes that can happen at the level of your entire body, including your vagina and vulva, including her libido and including her period.

Touseef Mirza:
You were going in there for a yeast infection swab. Yes. And then you just played Miss Inspector and just started to ask all these questions and connected them to realize that it was something completely different.

Dr.Sophia:
Completely different. We had to connect the dots. And when it comes to perimenopause and menopause, why women can end up seeing five different doctors before anyone makes that connection is because the symptoms can be so different or vague or, you know, a woman may think that the one symptom is isolated when it's related to three or four other symptoms. They may go to their provider and complain about one thing. So, for example, I mean, if you went to your doctor and said, Hey, I'm having headaches that are new. I mean, the first thing they're gonna think of, and your 40-year-old woman is probably, let me send you to a neurologist. It's not gonna be like, oh, are you having any changes in your period, you know what I mean? Like, that may not be the question.

Touseef Mirza:
Yeah. That does sound, when you put it that way, it does sound like a stretch. Right. So it's like, okay, I am having headaches that you associate with my period. Meanwhile, that is completely plausible.

Dr.Sophia:
Yes. Because an increased frequency of headaches can definitely happen. Or onset headaches can definitely happen during the perimenopause and menopause phase or transition.

Touseef Mirza:
You know, we love estrogen because that's basically the reason that can explain a lot of this.

Dr.Sophia:
Because of the 400 fun functions of estrogen, like I love to say, I love to say all of the functions of estrogen in our body, and that includes in our brain. And yes, fluctuations in estrogen affect the brain and can even cause headaches.

Touseef Mirza:
And that's what happens during perimenopause: a fluctuation of estrogen.

Dr.Sophia:
Yes. And yes.

Touseef Mirza:
And because of that fluctuation, it's changing how you were functioning before. Yes, 'cause before you were in balance.

Dr.Sophia:
That is correct.

Touseef Mirza:
So one thing I'm wondering, when you told her, maybe this is not just about the yeast, that it's actually about perimenopause, like what was her reaction?

Dr.Sophia:
I'm so glad you asked me that, because she was like, I don't know what you're talking about. She's like, what do you mean? I'm only 37? Meanwhile, we went down a different rabbit hole now if you need a pelvic ultrasound, you need to have a hormone panel done.

Touseef Mirza:
Why the ultrasound?

Dr.Sophia:
It’s to make sure that she doesn't have any of the other things we just talked about, fibroids or polyps. She'd already had a normal pap smear. So I wasn't concerned about something like cervical cancer or some abnormality at the level of her cervix. And I can tell already that she was experiencing some level of vaginal atrophy, and if she were sexually active and perhaps having bleeding after sex or something like that, I could also understand if she had some unscheduled bleeding or bleeding, you know, related to the dryness of her vagina. But that's not what she was describing. And at some point, she may even need a biopsy to make sure she doesn't have any abnormal cells in the lining of her uterus. I also wanna see, is she just perimenopausal?

Touseef Mirza:
And that's through the hormonal panel.

Dr.Sophia:
And you know, the funny thing is, when it comes to perimenopause, which is what makes perimenopause just so frustrating, you're catching a woman in a moment in time where actually everything can look normal. One of the markers that we look for is something called FSH could be totally in the low normal range, like low meaning your ovaries are just working like normal, because when you're menopausal, it's consistently high. The FSH, meaning above the level of 25, let's say that use that number as a cutoff consistently anytime you check it when you've gone through menopause, the FSH follicle stimulating hormone is always going to be above 25. But a woman who's perimenopausal, she can have a FSH, that's 2.4, which is like every other woman who's still getting a period. So it's hard sometimes to connect the dots, but let's say hers is 18, we are somewhere in between. And that could be the clue.

Touseef Mirza:
At least it gives you some indication.

Dr.Sophia:
It may give me some indication. Along with checking her estrogen levels, knowing where she is in her cycle. So it can help me to, you know, like decipher, well, what do I expect her hormones to be, the levels to be, and where she actually is. And that can give me another bit of a clue.

Touseef Mirza:
Did that confuse her more or did that bring more clarity?

Dr.Sophia:
I actually think it brought her some relief, although she was surprised, but I definitely think it brought her some relief because she's like that, so I'm not going crazy. I know I'm feeling all these weird different things. Mm. And perimenopause brings on that feeling, that feeling of am I just, I know something's off, but I just don't know what it is. And when you're able to put it together to say, Hey, I actually, I think all these symptoms you're having is related to this, it's like, oh, thank goodness.

Touseef Mirza:
There's a reason.

Dr.Sophia:
There's a reason. Exactly.

Touseef Mirza:
So then you also had a second patient, and she came to you for a different reason initially, versus the first one, who was because of the yeast. The second one was, 'cause she had-

Dr.Sophia:
The second one actually had bleeding, literally bleeding in between periods. The second lady was actually 42 thinking about a pregnancy and had had a few months of this irregular bleeding where she'd get her period, what she thought was a normal flow. And then 12 days, 14, 15 days later, she'd have another episode of bleeding. And then 10 or 15 days from there she'd get her normal quote unquote period. And so it was like, what's happening? I can't tell what's going on. I don't know if I'm ovulating. I don't know. I feel like I'm just having my period back to back and what does this mean for me? Am I going to be able to get pregnant? Like she was very, very concerned.

Touseef Mirza:
She was concerned about whether or not she could get pregnant.

Dr.Sophia:
Because she's having all this bleeding. She's like, I think I'm bleeding way too much. Which she was. But it was the concept of her, her, she was not thinking also despite being in her forties, that she was perimenopausal, and the possibility of, 'cause the concept, right. When you're perimenopausal, we also have to think about fertility issues. We just said that, though. She was thinking about her fertility in the sense that, well, I can't tell anymore right now. I can't plan a pregnancy because I don't know when I'm gonna have my period versus when I'm ovulating, because I feel like I'm just bleeding the whole month. But nowhere was she thinking, am I perimenopausal? And so in her case, of course, again, I wanna do a pelvic ultrasound to rule out anatomic reasons why she could be having this unscheduled bleeding, but two, again, hormones and in her case, fertility hormones.

Touseef Mirza:
But would you say that the second patient, it's a little bit, I mean, you, you're still in the part of the investigation to understand what she has, but it's a little bit less obvious that it might be due to perimenopause or not necessarily.

Dr.Sophia:
The problem with perimenopause is all of it could be related to perimenopause, whether it's the bleeding that she's having. And I think it's worth it to say that a woman in her forties who experiences unscheduled bleeding, especially for some time, a few months, should start thinking about, are these changes that are happening to me related to age and the transition time called perimenopause? And to have that evaluated, this is my point, is that changes in your period should be evaluated. Because it can help determine what your end goal is. In this woman's case, she wants to have a baby, and that may be more difficult in perimenopause.

Touseef Mirza:
So even if she's coming at you more from a perspective, am I ovulating or not? Or when am I ovulating?

Dr.Sophia:
She might not be ovulating.

Touseef Mirza:
She might not be ovulating because she's in perimenopause.

Dr.Sophia:
Right. Like her ovulation could be sporadic. Because she's in perimenopause. Exactly.

Touseef Mirza:
So it's almost like saying the starting point is to when things start to-

Dr.Sophia:
Go awfully different.

Touseef Mirza:
Yeah. Or just start to feel different is to say, aha, is this perimenopause? And just to at least bring that to the forefront.

Dr.Sophia:
I think it's worth it for us to bring it to the forefront because we know what's going on in our bodies. We know that something's changed, we know that something's different, but your providers may not make all the connections. So if we are not aware that it's a possibility. Then we may not bring it up. And sometimes you need to jog people's, like just kind of trigger them a little bit. You know, give them a little tickle. . In order for them to now move in a direction that's going to lead to getting to the root cause or the bottom line of what's really happening.

Touseef Mirza:
And also making sure that it's a comprehensive view. It's not just focused on one area.

Dr.Sophia:
One direction. We are bringing this up because we know that perimenopause and menopause are simply not talked about enough. And it's the reason why it's the focus of our conversation. However, the reason why I really say this is because your period can be a clue that something else is happening in young women in their thirties and forties. Unfortunately, these are the ages of women who die of things like cervical cancer. And it's because they have bleeding that's unscheduled bleeding. That's weird. Or what have you. That gets, keeps getting put off. Oh no, that's just your period. Oh no, that's just your period. No, it's not. It needs to be investigated.

Touseef Mirza:
So at the end of the day, it's really about self-advocacy,

Dr.Sophia:
Self-Advocacy. But start by always paying attention to yourself. As we say here, it starts with you embracing your body.

Touseef Mirza:
And when we say knowing yourself, it's really to become self-aware of changes, any changes,

Dr.Sophia:
Be in tune, know what's happening with you. Even if those changes are normal changes, that's okay. But just know that they're happening. Pay attention to your body because your body will talk to you. We'll let you know what's happening with it. So we always go back to this: embrace your body, embrace yourself. Thank you for listening to the Dr. Sophia Obgyn podcast today. 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.