Episode 4 : To endure or not to endure

Dr. Sophia:
Hello everyone. Welcome to the Doctor Sophia podcast. I'm an ObGyn practicing for over 15 years in my native New York City, and I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we will talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Hello everyone. It's me, Dr. Sophia, and on today's podcast, we will discuss, endure or not to endure. I'm joined by my co-host and my good friend, Touseef Miza.

Touseef Mirza:
Hi, everybody. So this is an interesting podcast that came to be considering, it’s one of our few new ones as we're starting off with, but we felt that it would be good to talk about something that actually came up when we did our first menopause podcast, which was our second podcast. And at a certain point in the podcast, Dr. Sophia said something of the sort that it's true that when women go through menopause, and I will say that's like myself, I'm almost going through menopause. I'm 51, so I'm perimenopause, like right at the cusp between perimenopause and menopause. That when women go through menopause since they feel that it's a natural occurrence, that maybe they shouldn't get any type of help along the way with what they are going through, hence, to endure or not to endure. Is it endure or endure? How do you say it?

Dr. Sophia:
Endure.

Touseef Mirza:
Endure. Okay. So can you explain a little bit like why you said that originally, like in terms of your experience?

Dr. Sophia:
So when I think about all the things that women endure, or the concept when we were talking about menopause, I brought up the fact that just because it's a natural process doesn't mean we have to suffer through it. I made the analogy of way back when we went through puberty, and we may have had acne, but when we had acne, we went out and bought all the possible things that can prevent acne; Clearasil, all types of different benzoyl peroxides, every single soap cream, lotion, whatever-

Touseef Mirza:
Everything under the sun.

Dr. Sophia:
-Toothpaste, Noxzema. We put everything on our face so that we would not suffer through puberty.

Touseef Mirza:
Even if acne was a natural phenomenon.

Dr. Sophia:
Acne can be a natural phenomenon during puberty. So likewise, when we think about menopause, my curiosity is why do women feel that? Hey, I'm going through a natural phase in my life, and not all women, just some, but the concept it's natural. I should be able to just go through it.

Touseef Mirza:
And I have to say I am guilty of being one of them. Like, I am like, okay, so, you know, like sometimes if I'm feeling more tired or if I gained a little weight last year and I used to have a little bit of hot flashes, but now I'm better. I used to say, well, you know, women have gone through this for thousands of years and they didn't need any type of treatment, so why should I, I should just go through it. But at the same time, there's another part of me, I have a science background and I really do believe in modern medicine, and I also do believe that, you know, if there is a better way to have a better quality of life, then you take it. So I don't know where that mindset was even implanted in my brain that I should just go along with it. Versus on the flip side, I was like, yeah, of course, if you have acne and you wanna fix it, have clear skin, you're not gonna say, oh, I'm just gonna go through this natural process. You're just gonna do it.

Dr. Sophia:
Yes.

Touseef Mirza:
So why is it specific to something? I mean, I'm sure there are other ones that we'll discuss, but where do you think that comes from?

Dr. Sophia:
I think as women, oftentimes it's kind of a little bit ingrained in us in our upbringing and society. The influences that come are that we're bombarded with this concept of either being strong women or we should be able to go through things.

Touseef Mirza:
Not complain.

Dr. Sophia:
Not complain, that's for sure. Or that we are looked, we are frowned upon if we are quote-unquote bringing up an issue or saying that we may need some assistance or help with something. And so I think that's a part of where it all comes from. And I don't wanna take anything away from going through a natural process for those of us who are able to feel very good in our skin as we go through any transition. I don't want to take anything away, but I also want us to feel very much empowered by saying, this kind of sucks, and if there's a better way, I'm all for it. And feel very much okay with that. So when it comes to menopause, if there are treatment options, and ways in which we can go through menopause without feeling so bothered by it, I think we should take it. I think it's fair to have a conversation with your physician. And say hey, you know, these hot flashes are really keeping me up, or these night sweats, is there anything I can do about this? Or some of the fatigue? Is there anything else I can be doing to help myself through this transition? And we should not feel bad about that.

Touseef Mirza:
When you start to pause and actually think about the root and the foundations of that and why we unconsciously, for me, it's even unconscious. It's not a conscious decision, it's just something that comes forth and I just go along with it. But then when you really start to think about it, that, you know, it comes from the conditioning. And on the flip side, I really wanna live a full life full of vitality. And that's when I started to think, okay, so I need to just open that aperture, open up the possibilities of that a little more. I think it's just really interesting that, you know, women, we also don't speak up all the time, you know, in society we're told to just like, you know, lay low a little bit and be quiet and not always advocate for ourselves and be nice-

Dr. Sophia:
We’re deemed either aggressive, whiny, or complaining.

Touseef Mirza:
Right.

Dr. Sophia:
And when you are advocating for yourself, you are none of those things.

Touseef Mirza:
Right. You're saying, I matter.

Dr. Sophia:
I want to be seen and heard, and you deserve it.

Touseef Mirza:
It's kind of a feminist thing when you think about it. It's kind of revolutionary because it's basically saying, I get to live the life that I wanna live.

Dr. Sophia:
And we should

Touseef Mirza:
And we should.

Dr. Sophia:
And that's the point.

Touseef Mirza:
Yes. Even, you know, as I am going through this now, it forces me to say, okay, am I gonna stand up for myself? And, you know and not just go back to the conditioning, but I think also what's important of what you said was it's fine to also go through the natural process. So therefore it's really a question to be conscious of your choices and not just go to a default.

Dr. Sophia:
Absolutely. We have a choice. We have agency over ourselves. If we embrace our bodies, understand what makes us tick. What will make us feel whole and vital and live exceptionally, and whatever that is for you, that is okay. And so in the conversation around menopause, I want women to feel like I can go through this natural process, quote-unquote, naturally. But to not feel ashamed, embarrassed, or weak because you've decided that you'd like to have some management of the symptoms that you're going through.

Touseef Mirza:
Right. Just because it's there doesn't mean that I have to go through it.

Dr. Sophia:
That's correct.

Touseef Mirza:
Especially if there are options,

Dr. Sophia:
And yes, there are options. So I think it's important for us to understand that point. It's interesting because it's not just in menopause we see this phenomenon. One of the areas that I like to think about is the birth process. As someone who has done a lot of humanitarian work and has done that work in places where women really don't have options.

Touseef Mirza:
What type of humanitarian work?

Dr. Sophia:
Well, I've done obgyn care in Haiti, which is my native country. And the possibility of having, let's say an epidural is simply not accessible, going through the birth process with the management of pain. Don't get me wrong, those women have learned many different ways of handling pain that speaks to their strength but certainly would have, I think, enjoyed the possibility or the option of something, for example, an epidural. And so even now, here in this country, I love going through the conversation of the birth plan. And I say that because oftentimes women may feel that in order for them to really experience childbirth, they have to experience all the pain that comes with it. As if there's some rite of passage. And the rite of passage is already there by becoming a mother, by going through the delivery process and whatever that may be, whether it's natural, quote-unquote, without any drugs, whether that's a vaginal delivery, whether that's a cesarean delivery, whether you have an epidural, don't have an epidural, whether it's a, a delivery that has to be provoked or induced. All of it prayerfully leads to a healthy mommy. Healthy baby, safe delivery. And so I like to go back to the concept, endure or not to endure, it's your choice. But to remember that we don't have to quote unquote go through a bothersome, painful process as some rite of passage or to be seen as strong.

Touseef Mirza:
That's true. It's almost like if we take an epidural or if we take a treatment, it's almost like we're cheating or something, you know, we're not doing-

Dr. Sophia:
We're not a wuss.

Touseef Mirza:
Yeah. Like we have to go through the real thing because that's what's happening. But who says that? Like you really have to think about the source of where those statements are coming from.

Dr. Sophia:
Yeah, What's the rule book?

Touseef Mirza:
Right.

Dr. Sophia:
But I do think that there is inherently a process that, in terms of how women are socialized to make us feel as though we must go through things in life in a manner that either can be painful. or can be discomfort or suffer even.

Touseef Mirza:
Would you say, 'cause you deliver a lot of babies, you, you talk with a lot of expecting mothers. Do most women have epidurals? Or is it like, do you have, just in your experience, like a ballpark? Like what would you say?

Dr. Sophia:
You know, it's interesting. I remember I had a 24-hour call where six out of seven of the women that I delivered actually went through the birth process without an epidural.

Touseef Mirza:
Wow.

Dr. Sophia:
And the way I like to describe it is a. having a certain level of understanding that your body is going through that process, and a willingness to kind of give into it. Two to have done some form of research maybe, or really communicate with a support person, a doula, or other birthing supporter that will help push through and, and give you other pain management skills. And three, I would say, I don't wanna just say determination because I think we're all very determined. But, you know, those women really, that's what they wanted.

Touseef Mirza:
They wanted to experience that. They really made the decision.

Dr. Sophia:
They made that decision. And it was a matter of being as supportive as possible with that decision. But at the same time, sometimes women make that decision and it's kind of either pushed upon them or they make that decision, and because they've made that decision, they feel like they can't turn back. They feel like because they voiced the fact that they wanted to go through it without an epidural, that when the pain becomes to the point where they may want it, that they want some relief, and then now they feel like they've failed. You haven't failed.

Touseef Mirza:
Oh. Because you finally asked for it.

Dr. Sophia:
Because you may finally ask for it. Or you may finally feel like you just can't do it anymore. It's not a failure. It's okay. It's an acceptance of your body's process. And so I say all that to say that it goes back to really understanding and being in tune with yourself so that you can make an honest choice. It doesn't have to be one that's simply brought up upon you because society says so. Your partner says so, your friends say so, your family. You, the person who's going through the thing, is the one who should be making that choice. And anywhere in the process, you are also allowed to change your mind.

Touseef Mirza:
You're not bound by anything.

Dr. Sophia:
No,

Touseef Mirza:
No.

Dr. Sophia:
Not at all.

Touseef Mirza:
And it doesn't, there's no judgment attributed to that.

Dr. Sophia:
Absolutely not. My favorite part of what I do is really reminding women to have grace with themselves. And so it brings me to another place in which I find that women endure or not to endure. Although in this particular instance, I would say that really it can have a profound effect. Some women have periods that are extreme, either extreme in terms of pain or extreme in terms of their bleeding-

Touseef Mirza:
In terms of their flow.

Dr. Sophia:
In terms of their flow. A flow to the point where they are anemic, a flow to the point where they are so fatigued, or debilitated that they have to take days off from work. It disrupts their lives.

Touseef Mirza:
Anemic because they're losing more blood than they should?

Dr. Sophia:
Anemia and anemic, yes. Because of the blood flow which leads to so many other things. So I often say, well, how long has it been like this? And they're like, oh, it's always been that way. And I'm like, at what point did you think maybe it's not okay, or it doesn't have to be this way. You know. But like I said, I think we take on this role somehow that, oh, well you know, I have to go through this. I have, you know, this is just what it is for me.

Touseef Mirza:
I would say also that when it comes to, I mean, just talking, I mean, I remember when I was a teenager, we didn't really talk about periods. Well, we don't, we really like to talk about periods now, just like hanging around. But if the flow was really a lot, I wouldn't know if it was normal or not. So for me, it would be like, well, I guess that's just the way it is. Because I remember when I was a teenager, like when I would have my period, like it was really painful, the cramps. And people told me, oh, that's just what your period is. So, you know, so you say to yourself, okay, well I guess, you know, you just take two Tylenols from time to time and, and that's just what it is. But at least you can talk about the cramps, but you don't really talk about the flow because it's such a personal thing. So I think there's also this stigma of not really talking about all the specifics of a period. So you just don't know how to gauge, I guess.

Dr. Sophia:
And I thoroughly agree with you. You're absolutely right. Most women don't have a point of reference. And so it's a place where we should be talking about it. We should talk about what is normal and how we understand our own bodies and what is too much, what is hard, and allow ourselves to have some openness with what we're going through.

Touseef Mirza:
This is like a paradigm shift really, of how you think about, is this something that is difficult for me? Because I think as women, I mean, I'll talk for myself, but as women, I've been so used to dealing with menstrual pain, we have that every month. Right. That becomes a default. And so I think our tolerance for pain is probably a little higher, but it doesn't mean that that's okay.

Dr. Sophia:
That's correct. It's not okay. It doesn't have to be okay.

Touseef Mirza:
That's what I mean by the paradigm shift. If we say to ourselves, well, any pain is not good, there might be a solution, so I should look into it. That's a completely different way of looking at things as a woman.

Dr. Sophia:
Right. And so for me, it's more so to feel a sense of comfort knowing that you don't have to just go through it. That you can bring it up. There should be some compassion to be able to say that I think this is too much for me. And is it okay to bring that up? Is it okay to say, I think my period might be too heavy? Or I think it's too painful.

Touseef Mirza:
To maybe even endure or not to endure is also not just from a perspective of getting treated, but it's also just a perspective of expression. It's just to be able to say it.

Dr. Sophia:
Yes! It's just to be able to, it's okay to say it. It’s the concept of what is going on with me and how do I actually feel about it? And I think we don't allow ourselves to do that. We don't allow ourselves to do that. We allow societal norms to dictate sometimes the experience that we have.

Touseef Mirza:
So when these situations happen, when you are with your patients and you bring them up certain solutions, like you are seeing them and you realize that there's a problem, let's say.

Dr. Sophia:
Yes.

Touseef Mirza:
And then you, you propose something to them. But because they don't think that this is, let's say for example, in menopause, they just think that's just the way it is. Are there certain things that you say to them or there are certain things that you ask them to think about so that they can make the right decision? Like how do you talk to your patients if that situation arises?

Dr. Sophia:
Well, I'll start by saying it's not a matter of a right or wrong decision. It's more so a matter of thinking about how do you wanna live your life? Either way is okay, but to be clear that it's a choice that you've actually thought about it. And so when I bring it up, it's not because I'm forcing the issue, but rather exposing the issue so that you can think about it and decide. A woman who is going through menopause, who's having, let's say 10 hot flashes a day or more, who wakes up every two hours with night sweats, the cover's on, the cover's off, the cover's on, the cover's off, who therefore is not getting enough rest, who is irritable or having a lot of emotional lability. And she may come in and just ask a question and not really realize that first of all, all of those things go together. And that the core issue is just the fact that they're going through menopause. And then that there may be something to help, you know, and I acknowledge the fact that the help may be, may seem scary. Y know, many women are frightened about all the possibilities, but there are, there are actually even natural options that women can, you know, lifestyle changes that they can make that can help them through the process, but they may not know.

Touseef Mirza:
Maybe also one of the reasons why we don't raise any issue is because if we do that, it's almost like we're acknowledging that something is wrong and we don't want to do that. And so we just continue the way we are. You know, we're just like, okay, no, everything's fine. Meanwhile, you know, I can't-

Dr. Sophia:
They're falling apart?

Touseef Mirza:
Exactly. But, everything's fine you know. And then the other thing I wanted to bring up is, that's a very good point that, you know, we're just talking about, we're talking about menopause right now, but even periods for somebody who's anemic, that's one instance, but it has a ripple effect.

Dr. Sophia:
Totally.

Touseef Mirza:
That is not just contained within that one scenario.

Dr. Sophia:
Absolutely.

Touseef Mirza:
So it also, I guess, depends on the type of physical situation or biological state that we're talking about. Right. So it needs to be addressed on a case-by-case situation.

Dr. Sophia:
Addressing it on a case by case situation. Sure. I think moreover, it's understanding that the ripple effect, the concept, how one thing can lead to so many other things in your life. So, you know, I like to call the woman who maybe has the period where she's kind of bleeding like a faucet. I'm like, this is like a crime scene period.

Touseef Mirza:
I mean, that's scary.

Dr. Sophia:
It's scary, But so many women go through it. So many women go through it. And sometimes by bringing it up, it allows us to do some further investigation.

Touseef Mirza:
So when you say bringing it up, bringing it up to…?

Dr. Sophia:
Bringing it up to your physician. Thinking about it for yourself, like, hey, something is really not right here. I know I've been going through this for a couple of years, but if I have to take a day off from work every single month because I'm on my period, maybe there's a better way. Maybe that's the one clue that I have a fibroid, that I have some other potential issue happening that's, that's actually anatomical. So when we decide that I'm going to understand and feel what's going on in my body and make a conscious decision that I maybe don't wanna feel like this anymore, I think that's the perfect time to say, I have to talk to my doctor. I have to talk to someone. And there's nothing wrong with that.

Touseef Mirza:
So this turned out to be a much more important conversation than I had originally thought it was going to be. I'm really happy we did that. So if we could do a couple of takeaways, what would those be?

Dr. Sophia:
I would say our number one takeaway. Know your body. Know your body. Know what you desire for yourself. The concept of being in your body, making a conscious decision about how you feel, what's going on, and the possibility of having to discuss those things that may be happening with you. Whether it's just as a conversation so that you completely understand what's going on with you or bringing it up because you'd like to see some type of change, but that’s okay. That we don't have to just because something is happening to us that we have to allow it or something that we think as it should be, quote unquote. The second thing I would say outside of unknowing or understanding your body is having grace with yourself in a way that if you want some help, some support, let's just put it that way. Because it could be in any way, shape, or form. That's okay. That is a good thing to acknowledge the fact that you don't have to either go through something, whether it's a loan, whether it's with some form of, you know, treatment option, whatever it is, it's understanding that, hey, this thing that I'm going through is kind of making me feel bad and I don't wanna feel this way anymore. Taking ownership of it. So I don't know if I have a third thing, but I'd start there.

Touseef Mirza:
Okay. I will add a third one just after our conversation, it is just to, no matter what you decide, that you have the right to change your decision without feeling judgment. Like you are allowed to decide in the present moment with your present state what you wanna do. And that you have the right to do so.

Dr. Sophia:
I love that. You're absolutely right.

Touseef Mirza:
Yeah.

Dr. Sophia:
That we can change our minds. We can live in the moment, and we can just be fabulous.

Touseef Mirza:
We can just be our fabulous selves at every moment in time. Yes.

Dr. Sophia:
At every moment in time. To end the podcast today I am gonna recite one of my favorite Maya Angel quotes. My mission in life is not merely to survive, but to thrive and to do so with some passion, some compassion, some humor, and some style. 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. Bye, everyone.