Episode 20: Perimenopause Crash & Burn

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.

As always, I am joined by my co-host Touseef Mirza. Today we are gonna talk about something that happened to me related to perimenopause. It was so hard for me to actually accept that it was actually related to perimenopause, so it makes sense that we call this episode Crash and Burn, because that's exactly how I felt. So, without further ado, let's get into it.

Touseef Mirza:
We just literally started to talk about our week, like we usually do, and we asked each other how we were doing, and you basically said, girl, I hit a wall.

Dr. Sophia:
I'm more than hitting a wall. I was going out of my mind.

Touseef Mirza:
Yes. You're just like, I don't know what's going on. The more that we talked about it, we realized that this is a very apropos episode. It's an episode that I think people will relate to because it's part of the lived experience that some people might be going through. So in terms of just starting the conversation, let's just start about how your week went. Like, let's say we started the conversation all over again, and about like a week ago or four days ago, I said, hi, Sophia, how are you doing? What's going on? And then what did you answer me?

Dr. Sophia:
I had a crazy week. I just felt like I was all over the place. So scatterbrained, I really could not focus. I could barely get my own work done. I couldn't sit down to do my notes. I couldn't sit down to focus on anything.

Touseef Mirza:
So this is not usually your MO, this is not usually how you function. Usually, you're pretty sharp and you know what needs to be done, like clarity in your work.

Dr. Sophia:
Well, here's the thing. I think anybody who knows me knows me as someone who's always into so many different things, kind of all at the same time. So I definitely would consider myself maybe a little hyperactive. My brain, I just always have a lot of different things going on, but it doesn't stop me from focusing on those individual things. I like to take on a lot of different tasks, but I can actually handle most of the time all those different tasks. So last week, it just didn't matter what I was doing. Like I had to get up, it didn't matter. I would sit down to do something and then just moments later I'd be like, oh, let me get up and use the bathroom. Then I'd come back and then I'd be like, oh, let me go get something to eat. Then I'd come back and then I'd be like, and let me go through my phone. Oh, I forgot to call somebody. Oh, I didn't write that note. Let me go back and write the note.

Touseef Mirza:
So it was just like, all these different types of inputs happening, but you can't really focus on finishing one thing.

Dr. Sophia:
I could not finish a single thing. I was like, oh my God. Like, holy cow. Like my ADD is on fire. Why? Like, what is the trigger? What is happening? It almost even felt kind of manic, like constantly high, you know, like on 10, but not really getting anything done or getting anywhere. And I was like, something's wrong. I know, I think I need some focus medication.

Touseef Mirza:
But it wasn't like something had happened in your life and all of a sudden there was a huge level of weight or anxiety that came out of nowhere.

Dr. Sophia:
No, nothing had happened. I didn't have any specific trigger. I didn't have any specific stressor or new thing that happened to be fair. The only thing that happened was that I had my period, you know? Oh my gosh. I'm saying this live. I had my period. I'm telling everybody. Okay. No, seriously though-

Touseef Mirza:
It wasn't PMS?

Dr. Sophia:
It wasn't like PMSing. If I feel PMS, I can literally say to everybody, okay, I'm gonna be a little crabby today, and I feel it and I know what's happening. It lasts probably for about 24 hours. Then the period comes, and then I'm totally fine. But this was like a whole week, a feeling completely out of my body, and I couldn't quite remember things. I felt completely unsharp, like I was so foggy in my brain.

Touseef Mirza:
But you were telling me that that wasn't when you were actually with somebody with your patients, it was really when you had to focus specifically, like when you were looking at the computer or something like that.

Dr. Sophia:
Yes. Definitely having conversations and talking to people and being in with my patients and thinking about what's going on with them. No, that I could handle. But when I had to sit down to actually write their notes down, or my thoughts, writing in their chart, documenting the, the conversation that we had and what their plan is, et cetera. Or even if it wasn't that, let's say I needed to send emails out or I just, I couldn't do it. I could not do it. I had to do evaluations for my medical students and that took me about half a day. I would start and I would stop. I would start and I would stop, and then I would think about it, and then like two seconds later I'd be thinking about the patient, and then two seconds later I'm thinking about my kids. Then two seconds later I'm thinking about my house. I'm thinking about, oh, I, did I talk to the accountant? Like it was out of my mind. There was a moment where I felt like I just like, like I wasn't functioning, but it's really with the administrative tasks that I had to do that I had to go through, like charting or, you know, the administrative stuff in terms of putting things into the computer and sitting really focusing on what I was writing and doing.

Dr. Sophia:
That's where I was having such a hard time really feeling like I was doing my job effectively when it comes to actually talking to my patients. Like honestly the concept of being an obgyn I feel like it's almost, it's just so ingrained in me and in my blood, but the idea of sitting in front of a computer was more than I could handle. I was talking to my friends and I was explaining how I was feeling. I was talking to my sister and, and it almost felt like I had pressured speech. I'm telling you, it really felt like what we would sometimes think about as a mania kind of a feeling, except I think one of the major differences is that I was clearly aware that I was in it. Like I was aware that I was not myself.

Touseef Mirza:
It was, but you just didn’t know why.

Dr. Sophia:
I didn't know why. That actually was the biggest part of the frustration. I think when people have mania, their body and their behavior is in it, but they don't necessarily know, or the awareness that they're in it.

Touseef Mirza:
I know that we talked and you told me that, and I said, well, maybe you need to run around or like have a punching bag and maybe you need to exert some energy. That's what I had to say. Maybe you have too much energy inside, like pent up. Pent up energy that needs to be released because everything else seems to be pretty stable and normal.

Dr. Sophia:
I needed to just go take a run or something, right?

Touseef Mirza:
Yes. Just like blowing some steam.

Dr. Sophia:
Nothing was gonna help me. I'm telling you I was losing it. I mean, it was to the point where I was like, okay, no, I need to call my- it was a Sunday, I was talking to my sister and I was like, I need to call my therapist. Like, I need a conversation. We need to talk, talk about this. We need to talk about why my ADD is on 10 and how I'm going to manage this on a Sunday morning. Like, I needed to talk to her right away. That's how anxious, frustrated, and unnerved I was by the way my body was behaving.

Touseef Mirza:
You don't even talk to your therapist that much.

Dr. Sophia:
No, I sure don't. I surely don't, I mean, it's a relationship that I've had for many years, but it's kind of like a maintenance touch in, you know, we were at the point where we maybe talk sometimes even just once a month. So the concept of this urgency of me needing to talk to her, and I did not have a new life event or a stressor or thing. Granted, this was stressing me the hell out.

Touseef Mirza:
If anything, your life's pretty stable.

Dr. Sophia:
Yes, yes. Yes. Exactly. So the thing that happened is, I said, okay, I need, at this point, I said some type of focus medication. That's where I was. Then I started talking to another couple of my friends and they were like, when's the last time you got your hormones? I said, hormones, girl, that's not the problem. Are you listening to me? I'm not focused.

Touseef Mirza:
It's about my brain. It's not-

Dr. Sophia:
Then you're like, no, I'm telling you it's time for your pellets. Here we go, let's talk about what pellets are.

Touseef Mirza:
Okay. I'm just gonna go even further back than that. Can you please tell your age?

Dr. Sophia:
Really?

Touseef Mirza:
You don't have to say the exact age.

Dr. Sophia:
I'm in my mid to late forties, closer to 50 than 40. How about that?

Touseef Mirza:
Perfect. So that people understand, when does this type of stuff even happen?

Dr. Sophia:
Well, listen, listen-

Touseef Mirza:
If we're gonna put it all out, I think we already talked about age, but anyhow, keep going.

Dr. Sophia:
You don't ask a woman her real age now. Come on.

Touseef Mirza
Fine, I'm-

Dr. Sophia:
No, it's fine. I am a very young 46-year-old woman.

Touseef Mirza:
You are a vivacious woman who happens to be the age of-

Dr. Sophia:
46.

Touseef Mirza:
Fabulous.

Dr. Sophia:
Thank you. Anyway, so I was not really prepared for them, my friends, to be like, girl, you need your pellets. You need your hormones. And I was like, my hormones, girl, I told you this is not the issue. They're like, really? Because you sound like the people we treat all the time.

Touseef Mirza:
These friends you're talking about, they're in the medical field?

Dr. Sophia:
Yes. These are the women who work with me, and we do special menopause and perimenopause treatments and hormone replacement for women. That includes hormone replacement with things like testosterone, not just estrogen and progesterone. We also do thyroid. It's a lot more than just estrogen. Actually, I have been on hormone replacement for some years now, starting only with testosterone because my life kind of needed it. I am pretty high functioning and I have all of these different things happening all the time. Testosterone is essential for our vitality, and our sense of energy. It's really made a difference for me.

When they said, you need your hormones, that's when I even had to think about it. I even may need a little estrogen. I wasn't experiencing hot flashes in the same way that we typically associate perimenopause, or menopause with the hot flashes, the real irritability. I wasn't irritable. I was just irritated with myself, not necessarily with other people. I wasn't like screaming at, you know, just being really short with people or anything like that. But for myself, I just was like, what the heck is going on? What is happening?

Touseef Mirza:
All right. So we're gonna pause here for a second and we're just going to describe what is perimenopause?

Dr. Sophia:
So perimenopause is the time that happens before you go through the full 12 months of no period called menopause. You go through 12 consecutive months without menses. We consider that time after that as menopause. Perimenopause is anywhere from 5 to 10 up to 15 years before you end. You have that final period.

Touseef Mirza:
And that's around, usually, women are around like 52 when this happens?

Dr. Sophia:
So menopause itself, the average age of menopause is about 51 in this country. For sure, a woman who's in her early forties can be experiencing perimenopause or those symptoms such as hot flashes, night sweats, insomnia, changes in their body, like joint pain, decreases in libido-

Touseef Mirza:
Brain fog.

Dr. Sophia:
Brain fog, memory changes, definitely energy changes, changes in their hair, changes in their skin, changes in their gut. I mean, the number of changes that your body goes through leading up to, and even after menopause are tremendous. Everybody doesn't go through it the same way. So you can have one symptom, you can have three symptoms, you can have five symptoms, you can have some symptoms at one point, others at another point. And it hit me like a ton of bricks. This is what I was feeling going on in my brain and in my body and how I was experiencing it. That sense of anxiety of losing it, of not being as sharp, of not being able to function was a symptom of perimenopause.

Touseef Mirza:
Before I ask you more questions about your perimenopause, the changes that happen in perimenopause throughout, up until menopause and beyond that, those are related to changes in our hormones.

Dr. Sophia:
Yes. Perimenopause, menopause, definitely understand that it is a hormonal transition that our bodies are going through. Perimenopause is this constant, I like to call it like a yo-yo, it's like up and down, up and down, up and down in terms of the hormones. They can be high, they can be low, they can be flat, they can be high again and low. It's like this constant upside down time period where you can still be getting a regular period every month. Yet you're experiencing all of these symptoms. Outside of that, you can be experiencing changes in your period as well. Your periods can be longer, they can be shorter, they can be heavier, they can be lighter, they can be more painful. They can show up anytime. That in and of itself can also make women feel very out of body because they don't know what to expect. Their periods have changed and they don't know why it's changing. You know, for some of us it seems like, okay, do we need to eat differently? Do we need to exercise more?

Touseef Mirza:
We think that we're doing something different, right? We're thinking it's something that we're doing that's causing potentially these different changes. Meanwhile, our body is doing what it needs to do regardless.

Dr. Sophia:
It has nothing, I mean, obviously, the way we eat, our lifestyle, is going to have a tremendous impact on how we go through this transition. There are things we can do to kind of help our bodies along throughout the transition so that it becomes more, certainly more tolerable, certainly more manageable, I don't even wanna say tolerable, but rather manageable, right? Those things, those options include our nutrition, how we exercise, including hormone replacement. Should we want it, it includes our relationships, it includes things like if we need to even have a therapist, but there's no one answer, right? All I know is that for me, it made me realize this concept. I tell people all the time that when women are going through this perimenopause transition, you can see five different doctors before they figure out that it's perimenopause.

Dr. Sophia:
Because I know for myself, a week and a half ago, I thought I needed to see a psychiatrist because I thought I needed somebody to prescribe me some Adderall. That was totally not what I needed. I am a doctor who treats women all the time, every day for perimenopause and menopause. And still, I had this episode and it just blew my mind. It's like this response that I had, it made me clearly understand how my patients feel. Because it's like, well, how can I-how did I go from last week to this week? Like, I was totally fine and I'm
totally not fine now. This can't just be, it's gotta be something else.

Touseef Mirza:
You know, something has changed, but it doesn't click that it can have this level of effect.

Dr. Sophia:
This early intensity, the intensity of the change from one day to the next. The way the brain changes in this transition, though, I can speak to my patients and say, have more grace with yourself. Accept and understand that we are going through this change. And then to figure out how we're gonna go through that change in a way that is manageable. Like I said, whether that's through exercise because we're gonna release some endorphins, whether that's through how we're changing our diet and eating more clean and more anti-inflammatory, et cetera, and including hormones if we want to. But I had never experienced it. I saw it in my patients and I had empathy for my patients. Now I am my patient. And it still hit me like a ton of bricks.

Touseef Mirza:
This is why we really needed to do this, because you are an obgyn. By the way, I'm so grateful to you for wanting to be so honest about this. We think of perimenopause of, you know, little things here and there, but we don't really understand the level of impact that it has, the level of the effect that it has. And so therefore we're just like, well, maybe this is not perimenopause. It has to be something else. You know, like in my mind, I didn't even know, uh, a lot about perimenopause. I might've had a couple of sweaty nights here and there, but I was like, It's okay. It'll pass.

But I didn't fully, I guess, appreciate the different types of effects that it has. You know, we focus on the effect, which was for you in terms if you couldn't focus. A lot of times, especially, I'm not gonna generalize, but a lot of times when we look in the medical field, we have a tendency to look at the effect versus really trying to dig deep and trying to understand the source of it. We're trying to really address just the symptom and not the source. So sometimes it can be really misdiagnosed. Would you agree with that?

Dr. Sophia:
Would you agree with that? Well, I know that perimenopause is misdiagnosed, left, right, and center. I know that for a full fact. But I think you bring up the point of impact. I could not even work effectively. I could smooth it over right? Except that I have 20 charts now that I need to go back and sit through, type up, et cetera. But it was affecting me at work. It was affecting how I was living my life. I have other very important tasks, not just in my job for my kids, for my house, paying my bills that I literally could not sit through and focus on. And I had it for a week. I was just like, no, something. I have got to take care of this. What is it? Right now. I need to know.

I can only imagine those women who are going through this, they have to either take time off from work or they're going to work and they're just not able to actually function at work. How other things, like the actual mood changes and irritability, the emotional part, the things, the other things that are coming with the frustration that you're feeling inside of yourself. I'm telling you, hats off to every woman who's going through this, because there is nothing about this that is easy. We have to band together to not just understand where we are in this life transition, but to really have empathy for each other and create a space where we can have this experience and talk about it so that we can then be clear on how we can manage it.

Touseef Mirza:
And also that we're not crazy.

Dr. Sophia:
We are not crazy. I felt crazy.

Touseef Mirza:
You felt crazy, but you are not crazy.

Dr. Sophia:
But I'm a hundred percent not crazy. I know I'm not crazy.

Touseef Mirza :
The body is just doing what it needs to do right now. The effect of it is that, but it doesn't mean you're nuts.

Dr. Sophia:
And let me tell you what was more funny is the fact that when my friends were like, hello, get yourself together and get your hormones.

Touseef Mirza:
Then were you skeptical when they said that? Or did you say, oh, right? How, how did I miss this? Like, how, what was the reaction?

Dr. Sophia:
I felt both ways. I really did. I felt like, what are they talking about? They don't even know what they're talking about. That can't be it. Did they hear me last week? I was fine this week. I'm not fine. No, that's not the issue. And then I was like, that might actually be the issue.

Touseef Mirza:
So then what did you do?

Dr. Sophia:
I got my hormones. What did I do? I got my hormones.

Touseef Mirza:
So what does that mean that you got your hormones?

Dr. Sophia:
So for me, hormone replacement looks like pellet therapy. H-R-T hormone replacement therapy. And for me, I do a replacement, both of testosterone and a little bit of estrogen.

Touseef Mirza:
This is based on your hormonal profile?

Dr. Sophia:
This is based on my own personal hormone profile. And it's also based on my own, like how I feel. And I already have progesterone. So all three of those things are being replaced. I was frustrated and relieved at the same time. I was like, oh, thank God. I'm gonna be fine. Literally just within days of going back, making sure I did my hormones, I felt like night and day I started to be calm. I started to be able to focus. I started to be able to do my work. I started to have normal conversations.

Touseef Mirza:
Because we've rebalanced the hormones at a level that they're supposed to be.

Dr. Sophia:
That is correct.

Touseef Mirza:
And the form in which you took the hormone replacement is in what form?

Dr. Sophia:
So it's called pellet therapy, the one that I do bioidentical hormone, pellet therapy. That is a small implant that goes just underneath the skin in the fatty tissue. The reason why I like it particularly is that it kind of is released in my body in a very steady state kind of way. So it kind of will bring the hormone levels up to a certain level and then kind of stay that way and coast and it slowly dissolves over time. It works for me, it works for my lifestyle. It's not the only method or way for women to have hormone replacement. As a matter of fact, it's probably not the most common way necessarily, but it's definitely an option. Hormone replacement can be via patches, via creams, via pills. So there are very many different ways of doing hormone replacement, but that's the way that works for me.

Touseef Mirza:
Okay. And so you took it and literally within-

Dr. Sophia:
Days.

Touseef Mirza:
Within days. So what, so what, what happened within days?

Dr. Sophia:
And it was so funny a few days later, and I was just like, I recognized the calm, I recognized I was just doing work actually.

Touseef Mirza:
That you were inputting stuff and it actually flowed.

Dr. Sophia:
I was just doing, yeah. I was just doing work. I was responding to my emails. I felt almost like I could remember things more. And then I realized, wow, I really just needed my hormones. I feel so much better.

Touseef Mirza:
Because by rebalancing the hormones, then your brain functionality could work the way it's supposed to. Because it's functional, it's functioning normally.

Dr. Sophia:
Yes. I had to remember that, for example, there are 400 functions in the body for estrogen.

Touseef Mirza:
Can we say that again, please?

Dr. Sophia:
Yes. Estrogen, estrogen, estrogen, 400 functions in the body and the brain.

Touseef Mirza:
This is so important because I think when we think about estrogen, we think about the uterus, we think about the vagina, we think about the reproductive system, but we don't really understand that it has so many other functions.

Dr. Sophia:
Your skin, on your brain, on your heart, on your bones. I mean, it's just vast.

Touseef Mirza:
And therefore, if the estrogen is outta balanced, it affects all of those areas that we just, that you just named.

Dr. Sophia:
Yes. Testosterone is an incredible hormone for calm.

Touseef Mirza:
It's not just for men.

Dr. Sophia:
It’s definitely not just for men. We actually, as women, have a higher ratio of testosterone, even to estrogen technically.

Touseef Mirza:
And, men have estrogen?

Dr. Sophia:
And men have estrogen too. Their predominant hormone definitely is testosterone. But yes, men definitely have estrogen too, for the same reasons we do. Because it can affect their skin, and it's protective for their heart. It's protective for their brain.

Touseef Mirza:
So now that you've come back to normal and we look back at what has happened, like, is there anything by looking back that you're just like, oh, yeah. That could have been a cue that was associated with my hormones. Or do you think you just had to go through the process that you went through in order to get to where you are now? Is it just about self-awareness or is there something else?

Dr. Sophia:
Looking back, I do think perhaps there is a little bit of self-awareness that goes into it. And being a little bit more even in tune and attentive to the fact that hold up, what's really happening? And what is this change that's happening right now? At least having it in the back of your mind that there's a possibility that this could be a hormonal imbalance or a hormonal issue that could be happening for me at the time in the moment, I just didn't even wanna think that that was a possibility because I was like, but I was fine.

Touseef Mirza:
Is it because you felt that the effect wouldn't be this drastic and you were just dismissed?

Dr. Sophia:
I think I honestly was even dismissing it for myself, though. I do not do this for my patients. But certainly, for myself, I was just like, no, how could it be this drastic? It can't be this drastic. It can't be this, all of a sudden I'm not having hot flashes. The hallmark of what we all think about. Granted, like I said, when I speak to my own patients, it's not like I'm like, oh, you're not, you're not having hot flashes. You can't be in perimenopause. Never, never.

Because when they describe to me what's happening, the fatigue, the joint pain, the fact that when they first get up, all of a sudden they feel like they're stiff, they can't move. I'm like, that might be your hormones, not sleeping. I did have a little bit of that insomnia. Like I had a couple of other things happening, but I was totally ignoring them as the possibility in the combination of all the things that could be happening.

Touseef Mirza:
It was really your friends in the medical field that pinpointed that. I think that's an important point because you-

Dr. Sophia:
It was my business partners and assistants who work with me every day. They were like, you know, this is what this is, right? I was like, get outta here with that.

Touseef Mirza:
But I think it's important also because it means that even if it's not happening to us if we see our girlfriends going through something like that, we can say, you know, have you thought about this? Because we might not realize it ourselves. I also think that even if you're an obgyn, this is why I love this conversation, is, you know, even if therapists have therapists.

Dr. Sophia :
That's correct. And even the obgyn needed an obgyn. I'm telling you right now because I was, I don't even know how to describe the level of frustration and anxiety that I was having with the possibility that I was losing my mind and worse yet not associating it with the thing that I really needed.

Touseef Mirza:
That, you know, so well, like the back of your hand

Dr. Sophia:
That I know, like the back of my hand. It was wild.

Touseef Mirza:
Okay. So now you go on hormones, two days later you're feeling much better. You're just like, that was it. So how are you feeling about yourself? You're just like, I should have known?

Dr. Sophia:
One hundred percent. The first thing I was like, what a dummy, why didn't I figure this out? Why did I let myself suffer? Why did I go through that?

Touseef Mirza:
Why? So why do you think that is?

Dr. Sophia:
Because we're women, because we're supposed to go through it because we're supposed to grin and bear it. Because we don't, we never think it's the thing and we blame ourselves.

Touseef Mirza:
Oh, we think we're crazy.

Dr. Sophia:
Or we really think that we are crazy. We're in hysteria.

Touseef Mirza:
Because that's what we've been taught.

Dr. Sophia:
Because that's what we've been taught through society. Just through all of the imaging the way that women are portrayed even in this process, going through perimenopause and menopause, whether you look at it in TV shows or in videos, but look at the face of perimenopause. I look at myself and I'm like, I am sexy, smart, hello. Business oriented, like successful and young at heart. In general, I feel very vibrant. You know, this is not the perimenopause of the back in the day with, you know, full of gray hair and you know, like the concept that you're like an old lady.

Touseef Mirza:
I also think that you know, we talked about Adderall, we talked, we didn't talk about antidepressants, but the conversation about antidepressants is a much more, I guess, culturally accepted conversation to be had more now than it was even like 10 years ago. But we're still not having the conversation of perimenopause in terms of hormones and perimenopause.

Dr. Sophia:
Exactly. Like for, I think probably for half of the women, this is the time of their lives that they are first diagnosed with a mood disorder in the first place. Imagine that. They've never been told they have anxiety, or depression. What I was going through was this extreme sense of lack of control, and focus. ADHD like I said, I've never been diagnosed with anything. But at the end of the day, I truly felt like that's where I belonged when that wasn't the case. I didn't-

Touseef Mirza:
Belong in terms of, in terms of mental health issues?

Dr. Sophia:
I'm not negating or disregarding women who have true mental health issues and that they need to have, that kind of treatment management of whatever's going on with them mentally. But the difference is we need to actually think could this be hormonal? It's not just, let me give this antidepressant or anti-anxiety, or in my case some type of stimulant to help me with focus. That just wasn't what I needed.

Touseef Mirza:
For the women out there that are anywhere between the early forties all the way down the line, post menopause, the whole shebang. Can't focus or you are having brain fog or having some type of different sort of experience than you usually do when it comes to your brain. What should a woman do First?

Dr. Sophia:
First I would say acknowledge it. Acknowledge what's happening in your body and what's happening in your brain. And know that it's not because you're going crazy. I would say second, yes, talk to your provider, your doctor, your obgyn, and say, I've never had these symptoms before, but this is what I'm feeling or what I'm going through.

Touseef Mirza:
Can they also say, could this be linked to my hormones?

Dr. Sophia:
I think they absolutely should point that out because it doesn't mean that your physician is going to automatically know that this is what's going on, or that they're gonna put two and two together or make that connection.

Touseef Mirza:
Or, because hormones are sometimes a touchy, touchy subject. They might not even bring it up. They might just say, you need to go see a therapist.

Dr. Sophia:
You're absolutely correct on that,

Touseef Mirza:
Right? So it's good to bring it up for yourself, and it might not be related to hormones like it could, but at least you are raising the point.

Dr. Sophia:
You are raising the question. Yes. You're raising the point. Maybe you can have a hormone panel done that can help to delineate if that is in fact the case. The one problem I would say is when we are thinking about perimenopause is that in general medicine, we would do a hormone panel during meno or perimenopause and everything would look fine. I think that's the hardest part is that all of the levels would just come back and, and they'd be like, okay, well your hormones are fine.

Everything looks good. That's not what's going on. And so it is important to see someone who either is doing this kind of work or who at least is very sensitive and aware of the possibility that this could be what's going on, and then can kind of walk you through all of the different steps of what you can try to help relieve some of the symptoms. Then to see if at the end of the day, whatever you're going through, all culminates at the end with perimenopause, or, you know, the menopause journey.

Touseef Mirza:
As women, we take a lot, right? We're able to take a lot, we're brought up in this system where we're conditioned to think certain things. And it goes back to a lot of the things we talk about in this podcast is that you have to go back to yourself and be gentle with yourself and not beat yourself down that something is wrong with me or, or I messed up or I didn't do this or I didn't do that. Actually, well, maybe my system is changing. I think that we need to just alleviate that level of, you know, we messed up. What, what did we do? What did I do this time?

Dr. Sophia:
What did I do wrong? I ate too much sugar. Oh my God. That was the other thing. I was like, oh my God, I have to cut everything out. I cannot, it must be because of the M&M’s I ate. It was so wild. I swear. I was like, clearly, it's what I'm eating. That's what happened. That's why I'm like this. It was wild. I don't even know how else to put it.

Touseef Mirza:
I mean, I will. The reason why I also am saying this is from my personal experience, I'm 52. I just started menopause, not like this year. I told you about it a couple of times last year, I am sharp. And so when I would do something, I just am very like, clack, clack, clack, clack, 1, 2, 3, 4, 5. I just, I guess it's called brain fog, but I never experienced that before. So I thought, oh, is it because I ate something, or is it because my dad has passed away with Alzheimer's?

Is it because now I have a brain tumor? Is it because, you know, maybe I am dehydrated? So I drank, I don't know, a liter of water, you know, I just, I was just like, something's wrong with me. Some, there's something I did wrong or my, my brain has gone completely in cahoots and then I talk to you, and you're just like, that kind of sounds like brain fog. I'm like, really? It's that powerful. Like I, it can actually like, not make me, it makes me tired and not think, but then the important thing, but I told you that, right?

Dr. Sophia:
You did.

Touseef Mirza:
You said, girl, that's brain fog. Like your girlfriends told you, you told me girl, that is brain fog. I was like, yeah, my hormones are doing that to me. Wow. That's pretty amazing. But the important thing was, the next time it happened, I'm pretty good with my menopause symptoms. It’s not that severe. It happened maybe 2 or 3 months later, I had that feeling again and my default was, oh no, what happened? And then I go, oh, hold on. My God, I think it's brain fog. That was such a relief for me. I was just like, okay, I know what's going on. Okay, hormones, I see you check and check. We will come back to this very soon. You know, but it was good to recognize it versus the other way. Also if you don't know, you stress the hell out girl. And you are miserable.

Dr. Sophia:
I was so stressed and I know better and I was stressed. I was stressed. So I am here. Honestly, we really needed to do this podcast because I said if I, me, the girl who knows what's going on could go through it. I have an even higher level, not only of respect for the patients that I treat and the things that they go through, but my level of care, I feel is even more, is heightened.

Touseef Mirza:
I would say also it's a humbling experience,

Dr. Sophia:
Right? Humbling to the max, right? I, I never put myself, let's say above what, you know, my patients can go through or try to think that, you know, it can't happen to me because it wasn't, I wasn't feeling like it can't happen to me. I just literally didn't recognize it. Humbling is a great word for how I feel now in terms of my ability to truly understand and empathize what's happening with my patients. I had to do this, whether, this is embarrassing, whether this is too much information, sorry for the TMI telling y'all I had my period, but I had to go through this. I had to share it with you. I had to share it with so many more of my actual friends and even my patients because we're all human. There is nothing above humans because I'm a doctor. I'm just someone who's here to try to help in this little time that we have here on earth.

I’m so thankful of the work that I do and the women that I work with, that they were able to help me recognize something that I just wasn't seeing for myself. They helped me get better. I'm just thankful.

Touseef Mirza:
Thank you for your openness. Not everybody would be so open in sharing that, especially an obgyn dealing with obgyn stuff. But I think it really shows the level of complexity and sometimes the level of layers that there is that we need to actually go through to really understand what it really is. You just explain that it makes us all realize if we don't see it too like it's normal as well, we're all in this together.

Dr. Sophia:
We're just all in this together. We're all human, we're all going through human transitions, and at the end of the day, we always have to embrace our body and embrace ourselves.

Until next time, thank you so much for listening to the Dr. Sophia obgyn podcast. See you later.

Touseef Mirza:
Bye.

Dr. Sophia:
Disclaimer, this is general medical information based on my professional opinion and experience, the content of this podcast is not intended to substitute for professional medical advice. Diagnosis for treatment. Listeners should not delay in obtaining medical advice for any medical condition they may have and should refer to their physician.