Speaker 2: 0:00

This episode sponsored by Stuart Arango Oral Surgery Learn more at saoralsurgeonscom and Kathy L Wall State Farm Agency Learn more at kathylwallcom. Welcome to the Bubba Lounge. I'm Martha Jackson, and today we are going to be talking about hormones. Everywhere I go right now, I feel like all the to be talking about hormones. Everywhere I go right now, I feel like all the moms are talking about hormones what is working, what's not, just some symptoms that they're having and things that they would like to improve and I feel like I have found the perfect person to talk to us.

Speaker 2: 0:39

Today. We have Dr Priya Patel MD joining us, who has recently opened a new practice called Feminology MD and Preston Center. Her practice is completely focused on the health and wellness of women, and she provides her service on a concierge basis. I recently visited with her and had an amazing experience, so much so that I wanted to share it with you all. So, in return for a trade out, I have invited her to join us today on the show. If you're having questions about hormones and hormone therapy, you are going to love the show. Welcome to the show, dr Patel. Thank you for having me. So you decided to go out on your own, which I always love. Talking about new businesses on our podcast. You decided to go out on your own about a year ago. Tell us about that experience. Tell us why you did it.

Speaker 1: 1:26

Yeah, so, absolutely so.

Speaker 1: 1:27

I was in a traditional OBGYN practice about 50% OB, which means delivering babies, and about 50% gynecology, which was, you know, more traditional women's health pap smears, bleeding issues, stuff like that and I just felt like the you know, in general insurance was significantly dictating care and unfortunately, I felt like the you know, in general, insurance was significantly dictating care and unfortunately I felt like that oftentimes limited the amount of time you could spend with the patient and even the different avenues of treatment that you could even offer.

Speaker 1: 1:53

So and I particularly felt that with GYN care and a lot of that was women's overall wellness and health and things like that that there really wasn't time to look at overall wellness and anti-aging and preventative health and that it was all really more treatment-driven and someone would come in with a problem and you would just try to slap a quick solution on it because you had 15 minutes and a finite period of time but maybe really they had a myriad of issues that need an hour to talk about and so I just felt like in my own practice personally that the women's health piece I always felt shortchanged and short on time and I felt like I was sometimes shortchanging my patients too, which I hated.

Speaker 1: 2:29

And so I sort of had always kind of had this idea that you know, I wanted to do women's well, women's health and overall women's wellness differently and better. And so I sort of, you know, grappled with how to do it and what that looked like, and finally I sort of decided that it was kind of now or never, and so I decided to leave my current practice. And then simultaneously I decided that if I was going to do sort of overall and more holistic women's wellness, that I really needed to sort of go back and get functional medicine training. So I went back, did additional functional medicine training and then got board certified in that, and then I felt like that, in combination with sort of my traditional gynecology training, would really round out the picture and allow me to better take care of my patients.

Speaker 2: 3:11

Well, I absolutely love that because you're so right, you do feel so rushed with your appointments and when you're going to the doctor. I actually have had a couple of doctors that I've had the opposite happen, that they talk to me too much and asked me too many questions and I started getting anxious because I knew that they had other patients that they needed to move on to. But then there was one incident where I had to see the PA because my doctor was not in on the day that I came in. Well, I got the experience for sure. She in no certain circumstances let me know how annoying she found me to be because I wanted her to look in my chart and find out my reaction to a certain medication and she said two different times you're asking too many questions and we only have basically 15 minutes and I need to move on. Like you were like taking too long on my day and it was very uncomfortable because I had some stuff going on that I wanted to talk about when I think it's frustrating, right?

Speaker 1: 4:11

A lot of times you're waiting to see the doctor for an hour plus. A lot of times you're waiting weeks to even get the appointment and then you're waiting an hour at the appointment and then you have a list of things to go through and then a lot of times you're really rushed to even get through that. So you've now waited weeks or months for this short period of time and then you can't even get through everything. So, yeah, I mean, I think that's incredibly frustrating for people and I think, unfortunately, what we're dealing with more and more in our healthcare system, unfortunately, right, right.

Speaker 2: 4:45

Well, I know that you offer a huge full gamut of services like so many things that we could probably fill up the rest of the year with episodes on, but I wanted to focus on hormones because everywhere I go, every group of women I'm around it feels like everyone's talking about it right now, and I'm sure it's the age that I'm in that people are talking about what's working, what's not working, problems that they're having, who should they go to, who should they see? So tell me about that, because a lot has changed over the years in regards to hormone therapy. At one point in time, we were told specifically estrogen was really bad for us, it causes cancer.

Speaker 2: 5:18

But new studies have come out and we're seeing things differently. Talk to us about that. What's changed over the years?

Speaker 1: 5:23

Yeah, so really a lot of our data and understanding of hormone therapy, originally initiated with the 2002 study called the Women's Health Initiative, which really shaped the narrative for the next 20 years, and from that study, sort of initial preliminary data suggested that well, it was really so. They looked at estrogen and progesterone, which is another hormone that we sometimes supplement with, and they found that progestin, which is a synthetic derivative of progesterone it's all very confusing potentially may have very little but very minorly increased the risk for breast cancer in a certain subset of patients. Now, over 20 years, additional data, additional studies we've now realized that actually one that study was faulty. It looked at a older patient population that was typically older than 65, which is not even who we are usually initiating on hormone replacement therapy. It's usually something that's initiated much earlier as women navigate menopause and the average age of menopause excuse me is 51.8. So obviously you're dealing with those.

Speaker 1: 6:29

You know initiation of hormone therapy typically much earlier. So one, the study was flawed because it was looking at a much older patient population. And then, two, they realized that it was looking at a completely different form of progesterone, a synthetic progestin that we don't even recommend using anymore for hormone replacement therapy or at least it's not our first choice and there were a lot of other semantics and nuances that I could bore you with. But the bottom line is that that study we realized was completely incorrect and when we did additional studies and looked at different forms of medication and different ways that we could give back hormone replacement therapy, it actually completely shifted the narrative and we realized that the original data that we were sort of practicing medicine with for the next 20 years was wrong.

Speaker 2: 7:14

Well, I mean it's just so unfortunate that they do all these studies and it's supposed to last 20 years, because I mean things are ever evolving and changing by the day and so I don't know. That's just too long.

Speaker 1: 7:27

Well, and you know it was, it was it just I think it was a study that was particularly well publicized.

Speaker 1: 7:34

And even as doctors I mean, when I trained more than you know, I trained 15 years ago we really were taught that you know hormones, you want to use the smallest dose for the shortest amount of time, only for the people that need them. And it was because we sort of feared hormones and we thought that they were going to cause all of these potential adverse effects, and so I think we were truly I have the same problem. So I think we were actually, you know, as doctors we were sort of practicing out of fear. And then with additional studies and data and time, it became more and more apparent that actually it doesn't increase the risk that we thought and that in fact estrogen probably decreases all-cause mortality and that it reduces the risk of osteoporosis, reduces the risk, you know, probably has some cognitive benefit, may even reduce the risk for dementia, has cardiovascular benefit, can reduce the risk for adverse, you know, heart outcomes and cardiac issues, and so that really the benefits far outweigh the risks if you really understand all of it and the nuances.

Speaker 2: 8:36

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Speaker 1: 9:43

Yeah, and that's actually a hard question to answer. I think it really is on a case by case basis. I think it depends on the other medical issues that a woman is dealing with. It depends on why and when they initiated hormone therapy, what hormones they're taking, what their current symptoms are, and I think you sort of have to put all of that together to sort of determine what makes the most sense for that person. But I think that is very individualized.

Speaker 2: 10:08

Yeah, that makes perfect sense, as with any medical treatment.

Speaker 1: 10:11

But I think on average, you know, assuming that a woman initiates hormone therapy, you know, in her early 50s, you know probably realistically you could at least be on it for about 10 years, okay, and some may be on it a little bit longer and some shorter, just sort of depending on their health circumstances and what's happening.

Speaker 2: 10:28

Okay, okay. Well, I have definitely gone through menopause. I am in my fifties and I did start hormone treatment in the earlier part of the fifties and I felt really good, like leading up to 50 and leading up to menopause. I mean probably better than I had in many, many years, like lots of energy and really really great. And then all of a sudden poof, one day all the energy was gone, the brain fog, everything happened and I got my hormones tested and I was out of everything.

Speaker 1: 10:56

Yeah.

Speaker 2: 10:56

And I just felt awful. And so I mean tell us some of the symptoms people should be looking for, so they know that they're not going crazy and that maybe they should have their hormones checked.

Speaker 1: 11:08

Well, the list is long.

Speaker 1: 11:09

And I think I would tell you you're actually one of the lucky ones because some women deal with like perimenopausal symptoms for 10 years leading up to menopause. Oh, I've heard that, yes, so you know, sometimes it's not uncommon to have a 38, 39-year-old or even a 40, 41-year-old who's already battling a lot of these perimenopausal symptoms and they're like well, I feel like I'm too young for menopause, I'm still having cycles. But you know they may be having perimenopausal symptoms because they're having significant hormonal shifts that are causing symptoms. But to answer your question, what could be these symptoms? So, more traditionally we think of hot flashes, night sweats, fatigue, brain fog. You know, memory changes, mood swings, irritability, emotional ability, check, check, check and then some of the other things you know we can have vaginal dryness. You could have decreased sex drive, pain with intercourse Sometimes it can actually worsen urinary symptoms like you could have increased urinary incontinence where you're leaking more, or even urinary urgency, or having to go to the bathroom more often, or sometimes feeling like you need to avoid and not being able to make it in time to the bathroom, and then even sometimes other, you know, very commonly difficulty sleeping, or sometimes you can get to sleep, but then frequent nighttime wakening and you know your mind's racing harder to get back to sleep.

Speaker 1: 12:32

So, in general, disrupted sleep. Sometimes you can have a worsening of anxiety or new onset anxiety Same thing, sometimes a worsening of depression or just kind of new onset depressed mood or just sort of feeling down or hopeless. Oftentimes you can either sometimes more atypical symptoms like joint pain, dry skin. Some women will have a flaring of acne, which is a real doozy.

Speaker 2: 12:57

We all love that one. You're old and you're breaking out. You're like isn't this the one?

Speaker 1: 13:00

benefit of getting older. It turns out it's not. And then weight gain or just inability to lose weight, and then a lot of that is that sort of central weight gain where they're like I'm just gaining weight around my midsection, I can't get it off. Nothing I do makes a difference. Some women can have headaches, gum disease. That's a lovely one. Yeah, this is a lovely one. Yeah. This is a very long list, I'm sure I'm leaving out a whole myriad of symptoms, but those are the ones that are top of mind.

Speaker 2: 13:31

I wanted to give a personal thank you to our good friend and show sponsor, kathy Elwall State Farm Agency. We have known Kathy for more than 15 years and there is no person we trust more when it comes to insurance than Kathy Elwall. Kathy is always available to help you find the right insurance for your family needs, whether it's covering your home, auto or providing a life insurance policy tailored to the unique needs of families in Highland Park. My family trusts Kathy with our insurance and we hope you will too. Please visit kathylwallcom to learn more and let her know that Martha from the Bubble Lounge sent you. Well, let's talk about hormone therapy, because I know there's different ways to do it. There's pellets, there's creams, there's pills, there's this and that I probably don't even know everything that's available anymore. But what I'm? Again, I'm sure it's individualized, but how do you approach therapy with your patients?

Speaker 1: 14:22

So I usually you know typically will get labs to sort of understand where they're starting and where their numbers are starting. And then I typically will sort of combine that hard data with symptoms because both are sort of equally important. You know sometimes numbers. You know we say numbers don't lie, but sometimes numbers are not exactly congruent with how someone is feeling. So you really have to look at labs and numbers in the context of how they're actually feeling and together you really get the whole clinical picture. Then, once you sort of understand the clinical picture and where they're at, we really look at what symptoms they're having and what issues we're trying to solve and what their goals are, depending on what those symptoms are. And then typically you'll look at someone's health history and what their pre-existing medical conditions might be, whether they have high blood pressure or history of cardiac disease. Then a lot of times you'll look at family history and whether there's heart disease or dementia or other things like that. And then, once you sort of have that full picture, then I typically will walk through what the different options are.

Speaker 1: 15:25

You know traditionally, you know I would say once upon a time we would quickly reach for oral estrogen. That was sort of the easiest thing to give. It was cheap and it worked. But really, now we understand that oral estrogen is the only form of estrogen replacement that really is associated with increased risk of stroke, increased risk of blood clots, like DVTs, and even sometimes increased risk of heart disease, like heart attacks, and things like that. So now, often don't reach for oral estrogen as our first choice.

Speaker 1: 15:57

So then that leads you to the other choices, and so there's creams, there's patches, which are very commonly used, and then sometimes pellets are another option for individuals that don't necessarily want to have to use something daily or multiple times a week. And then, as we work through which option is best for each person, you know then kind of talk about do you want to use something daily? Do you want to use something weekly? Do you not want to? You know, do you want to use something daily? Do you want to use something weekly? Do you want to do something every three months, so that you're not having to do anything on a daily basis? And so just understanding those different things and lifestyle and what is going to be most convenient to someone, and then what they're actually going to follow through with, Because if you give someone something daily but they don't take it. It's not going to work.

Speaker 2: 16:42

Now I find that so interesting, what you said about estrogen, because a few years ago I was complaining about some symptoms to my OBGYN, who I absolutely adore. She delivered both of my kids, she goes to my church, she lives in the neighborhood. I think I would be best friends with her if she wasn't my doctor, but based on the things I was telling her, she goes well. I would just give you estrogen without even looking at your blood work, and that just didn't feel right to me, Like that is why I have chosen to go to someone that is a little bit more specialized in the hormone therapy.

Speaker 1: 17:13

And I think you know a lot of that is just because I would say, you know, and I don't want to ruffle any feathers with this but I do think, with OBGYN sometimes I mean I am an OBGYN so I'm talking about myself but I do think, and this is probably a function of our healthcare system in general, but through residency training and you do four years of OBGYN specifically after four years of medical school, so you think that would be an abundance of time to get adequately trained on hormones.

Speaker 1: 17:42

But I do think that you know, in general, hormones I feel could be better taught in residency and that was one of the reasons I really felt like I wanted to go back and do the functional medicine training is that I felt like I had a lot of the knowledge but that the field was ever evolving and you know, the information I had was more than 10 years old and so I think to really stay up to date on that, it's something that is constantly changing and what I was taught even in my training more than 10 years ago is different than, I think, a lot of the information we know now. So I don't think it's that anybody by any means isn't trying to do the best thing for their patient. But I think there's just a lot of nuances that we're understanding. You know, year after year that is just different than maybe what people were taught when they trained.

Speaker 2: 18:28

Sure Well, I mean, there's just so much in the medical field for you all to keep up with like it would be hard to be an expert in every single area. So I like what you're saying. I do feel like that they should teach more with the hormones, because it's such a huge part of how we're feeling.

Speaker 1: 18:43

And I mean I myself thought I mean maybe this was isolated to my program, but in talking to a lot of colleagues as well, they feel the same that you know we get phenomenal surgical training, phenomenal obstetric training and OB training and all of that.

Speaker 1: 18:56

But and I think this just goes back to women's health in general that I think sometimes the hormone piece of it is sort of glossed over and that's just sort of, I think, how traditionally things have been done for decades and a lot of textbooks were written 30, 40 years ago, right, and then they've just sort of been updated, but the fundamental principles and what was in there have been around for decades. And I think a lot of times that you know, 40s and 50s in women's health was just sort of glossed over and there was a little bit of a grin and bear it mentality and I think women are tough and they did grin and bear it really well, and so I think it was just sort of ignored, which is, you know how we ended up here. This is probably, you know, I think decades of women probably needlessly suffered or didn't maybe get optimal treatment, because it just wasn't something that we looked at perhaps as closely as we should have.

Speaker 2: 19:50

Yeah, I absolutely can't imagine just suffering through this. Like I said, leading up to it I felt amazing, but then afterwards, just a huge crash of energy and brain fog and I still don't think that we have our hormones quite right with me. That's why I started coming to you. I'm a new patient and I'm hoping that we can get things ironed out, because I do lack energy and definitely the brain focus and motivation to get through your day-to-day grind. But I feel awful for those people you know before us who just had to grin and bear it like what you're saying. That's so sad. It is actually really sad.

Speaker 1: 20:29

I also think it's a testament to how tough women are we really are, because I think for decades we just dealt with it and it wasn't. You know, it's not necessarily something that's glamorous, or you know that the pharmaceutical you know a lot of times pharmaceutical industry goes after high dollar items and, and you know, hormone health is maybe not necessarily one of them, and so I think it just kind of got put on the back burner or just it wasn't where high dollar amounts were going towards. You know, research funding.

Speaker 2: 20:58

Well, how can somebody that thinks that maybe they need to get on hormones? What kind of route should they pursue?

Speaker 1: 21:06

Yeah, I mean, I think you know the first step is to really take stock of how you're feeling. I think you know I kind of alluded to this several times, but I think oftentimes as women, we just sort of make it through the day. Right times. As women, we just sort of make it through the day, right, we're in a little bit of a survival mode. A lot of us have children and you're just running around and prioritizing everyone else first and I think we often put ourselves on the back burner, right, you're just trying to make sure everybody makes it through the day and it's, you know, one crisis to another or just day to day, and you're like eventually I'm going to get to myself. But sometimes that eventually never comes because new things come up. So I think first is to just, you know, take stock of how you're feeling and really just pay attention. You know, see how energy feels like when you wake up, see how you're kind of doing through the day, pay attention to what you're eating, what you're putting in your body, right, we now understand that gut health and nutrition and all of those things play a huge part in hormone health, and you could slap all the hormones on somebody, but if they're not eating well, if their gut health is not in a great place, nutrition is poor, it's only gonna do so much. And so really you have to look at the body as a whole, and I think this goes with any medication. When you're solving a problem and in healthcare in general, when you're solving a problem you don't wanna just solve that problem, you really need to look at it as a part of everything, so that you're going to solve that problem. But overall everything should sort of function and do better because we have one body, and so to really think of it as separate systems is not really how the body works. You know, we really need to think of it as sort of one unified entity and understand that if we fix this thing, how is it going to affect everything else? So I would say, you know, one is just take stock of how you're feeling and then once you sort of identify, okay, I feel like this isn't great, or this isn't great, or this feels different than it used to be, then I think it's important to probably, you know, see an OBGYN.

Speaker 1: 22:55

If you think it's a hormonal thing, if it's more of a primary care issue, then obviously a primary care doctor. But I think if it's more of a hormone health stuff, then I think typically an OBGYN is where I would start and then sometimes, if you can combine that with functional medicine sometimes that's not always bad either, depending on what's going on and then usually lab work right, and it's important to sort of have that discussion with the provider and talk about what your symptoms are and then they'll determine what workup is appropriate. Whether that's just traditional lab work, whether they think there's actually something specifically wrong or if it's just hormonal changes, whether they feel like additional functional medicine testing might be necessary, just kind of depends. And then they can sort of you know and you can decide together what workup seems appropriate.

Speaker 1: 23:40

And then I think you do the, you know, you do the lab workup, do whatever is necessary, get that testing done, and then you follow up and then sort of go through those results and then make a plan for what makes sense, whether that be hormone replacement therapy or for some people that's not the solution. For some people it might be a thyroid abnormality or there's just a big you know there's a big nutrition gap and you know they have a lot of gut inflammation and that might be the source of a lot of their issues. So I think it's really you know kind of identifying what the different sources of are of their symptoms, and then you know solving them one by one.

Speaker 2: 24:14

Well, so I love everything that you're saying and, like I said earlier, as I'm a new patient of yours, I literally have seen you one time and we've had our initial meeting and it did go on much longer than 15 minutes. It went a little longer than it should have, right yeah?

Speaker 1: 24:29

it was longer than an hour.

Speaker 2: 24:30

I love how much time you spend with your patients, but walk us through the process of coming to see you, because so many of us are used to only going to providers that take insurance and you're concierge, so tell us about that whole process.

Speaker 1: 24:43

Yeah, so just because of all of the constraints that insurance sort of places on time and even services that they'll cover, et cetera my practice is concierge in that it's cash-based, so there's not a certain fee that you pay for access for a year or anything like that, it's just fee for service, meaning you pay per visit, and I typically will start with a 50-minute so almost an hour new patient consult where I will walk through all the symptoms, really understand medical history and what your goals are.

Speaker 1: 25:12

Typically from that we'll determine together what labs and maybe additional functional medicine tests we may or may not need to do, and then I usually will have you follow up for another 50-minute or almost hour visit. So we've now almost spent, you know, by the end of that, typically two hours together and at that follow-up visit we usually will sort of walk through all of the symptoms and then make a plan for how we're going to address each of those things and then typically we may follow up six, eight weeks later, depending on what treatments we initiated and if labs are necessary, things like that. But my goal is to really sort of, you know, within those two visits, really have someone leave with a comprehensive plan in place and then after that we're really just needing to follow up as needed for maintenance or tweaks or things like that, or if some certain symptoms weren't solved, then we can sort of follow up and address those things. So that's typically kind of the process.

Speaker 2: 26:01

Well, that sounds easy enough. Well, how can our listeners find you?

Speaker 1: 26:04

Yeah, absolutely so. Our practice is called FeminologyMD, so our website is wwwfeminologymdcom or Instagram FeminologyMD, or you can always call our office 469-242-6292. Perfect.

Speaker 2: 26:21

And she is conveniently located in Preston Center, right in the bubble. Well, dr Patel, thank you so much for joining us today. Everything that you shared was so valuable and I know it's going to help a lot of women out there.

Speaker 1: 26:34

Thank you so much for having me. It was a pleasure.

Speaker 2: 26:37

That's been another episode of the Bubble Lounge. I'm Martha Jackson and we'll catch you next time.