What Every Woman Deserves to Know About Her Health

[00:00:00] Speaker A: So it's really important that women Understand this is 40% of our life where we're going through this incredible transition and it's affecting every part of our body as we're going through it. [00:00:22] Speaker B: Welcome back to Riding the Big Wheel. I'm Michelle Seager, your host. And today I am so, so excited that we have Dr. Mia Chorney with us. Dr. Mia Chorney is the Chief Medical Officer of the PAWS AI and she combines over 30 years of healthcare experience as an expert in women's cardiovascular care, menopause, and leveraging artificial intelligence in clinical healthcare applications. She is also director of hormone health and precision medicine. That's genetics for those of you, like me, who may not have known that. And and is a Women's Scientific Advisory Board member. Welcome, Mia, and thank you so much for joining us today on Riding the Big Wheel. [00:01:07] Speaker A: Thank you, Michelle. Super excited to be here and tackle these topics with you. [00:01:12] Speaker B: Oh, yeah. Today is going to be super exciting. We are going to be talking about two big healthcare areas for women. The biggest areas of impact were going to talk about heart health, cardiology and menopause. We're going to cover what everyone needs to know and most importantly, what women can do now to engage in meaningful preventive and ongoing care. Dr. Mia is also going to talk to us about the history of women's healthcare, common myths and misconceptions about hormone replacement therapy, and so much more. So, so I thought, Mia, we could start with you just talking to us a little bit about your background, who you are and how you got into what you do today. [00:01:59] Speaker A: Thank you, Michelle. I would love to do that. So I'd love to share the story. You probably know I've been on NBC, Fox, ABC, and I gathered attention because at the age of 32, I was the director of the OR. And the last thing I remember is walking in to check on my staff. The bed was on the left. I supposedly, I made it out in the hallway and I went down and I ended up cracking my head open, being unconscious for three hours and waking up in ER going, what just happened? Long story short, to pull it all together, diagnosed with a cardiac condition. But I went through a lot of dismissal, a lot of she's just four months postpartum, she's tired, she's exhausted. And that really, really pivoted my passion for women's health, health care and being an advocate of where we need to go. I'm going to save my Big Wheel movement for you for the end of what's happened since then. But that really propelled My continual quest of, you know, always learning, re educating, staying current with the guidelines. Because what I know is as soon as I learn something and I something new to me, you know, what you realize is then you realize there's so much more you don't know. And to make sure we're staying current. [00:03:16] Speaker B: So tell everyone. That was a very pivotal moment for you. So talk to everyone about like, what is it that you're doing today and you know what, why you chose cardiovascular health, like women's health. And then you became this specialist in menopause. What really drove the decision around that? [00:03:38] Speaker A: Yeah, so I ended up naturally drifting towards cardiology care because my cardiac health has had some bumps them since then. You know, I was training for the Grand Canyon to run north rim to south rim two years ago. Ended up needing to lie down on the trail with my husband training again. It came back, my arrhythmias, those issues, going through a lot of self dismissal, those sort of things. But then when I specialized in cardiology care, all of my women were in menopause. And it's really important for us to realize that I needed to become a great advocate for them and an incredible practitioner for them. So that's how those two pieces really blended together. And then I really wanted to set myself apart providing really, we call it epigenetics. So understanding people's environment, precision medicine. So that's how the whole genetics piece and specialization came into that. [00:04:37] Speaker B: Wow, you're. You're definitely one of the women on my top five of women I admire. I. So let's discuss. I want to talk about two things. Today we said we were going to really get into heart health and then menopause, which I'm super excited. So let's start with cardiology. We'll kind of break that down. One of the most shocking things and I don't know how many women are aware of this, but I didn't know it was the number one killer of women in North America. And one woman dies every 80 seconds. And there's a high risk for pregnant women. They're even at higher risk. So like, why do we not know about this? Why is this happening? And like what's going on? We all know it's what happens with men. So just give me a little of your history there. [00:05:26] Speaker A: Yeah. So heart disease is the number one killer of women in the United States. You're right. One woman drops dead every 80 seconds right now. And what's really important for women to know is that all cancers combined do not equal the death Rate of heart disease. Not that cancer is not important, because it's very important. But we need Michelle to get people to be aware that this is the number one cause of death, because most women do not know that. And so we really need to advocate for that. And you brought up maternal health. The number one cause of death of our pregnant women in the United States is. Is cardiovascular disease. These women tend to die within 42 to 50 days of discharge from hospital. And what's really sad is the United States has the highest death rate for our maternal population than any developed country in the globe. And this is very stunning to us right now. So we have a lot of work to do globally and here nationally to advocate for women's health. [00:06:37] Speaker B: Why do you think so? I think about. I just got back from New York and I did a run. It was a fun run, but it was about breast cancer. And I ran with my sister, who is a survivor. I have never looked at a race or a run or a bike ride or whatever that's around cardiovascular health for women. Like, what is that all about? Why do we not know? [00:07:03] Speaker A: We just. We really need to get out and advocate. We really, you know, we need to be looking at organizations like the American Heart Association. You know, I sit on the board of directors there, advocating go Red for women. That's in February. But we need to get the message out there. What's really, really important, Michelle, is that our age group in the 30s, is the age group we're most worried about right now, because they don't know. And their risk factors are escalating with our current lifestyle. We have are women in the 50s and 60s. It's still very, very high, but that rate is plateaued. But that's our next generation of women that we're really frightened about. And then, as you've heard, they predict that our children's children will die before us with the way we're currently going with our health in the globe. [00:07:53] Speaker B: Yep. Well, let's get into that a little bit. It would be great to talk about things that are going wrong. Right. Like, what is it that's impacting and increasing the odds for younger women? It seems, you know, here we are in the United States, access to medicine, so we believe very developed nation. Right. But something's going wrong. So talk to us a little bit about some of the things that have changed about our lifestyle. Eating, whatever that may be that's impacting cardiovascular health. [00:08:29] Speaker A: Yeah. So we call it the essential eight. And so we're really needing people to focus on you named it exercise. Women are not getting the exercise they should be getting. Obesity is rampant. It is growing year after year after year. If you look at the heat map for North America, it is quite frightening to look at 10 years ago and where we are today. And a lot of that comes with multiple factors contributing. We know that socioeconomic factors also, you know, all of those pieces contribute more to our health than actually a provider does. And that's very well founded if you look at in the literature. So we just need women to really be aware. You need to be exercising, eating healthy, you know, watching your alcohol. We know alcohol contributes to breast cancer now. Right. And women need to be bringing down their alcohol. All this new literature and evidence based medicine, we just really need to get out there and doing things like you're doing, doing to help educate everyone. What's happening. [00:09:31] Speaker B: That's great. So let's think about. That's really good practical advice. Oh, I've got a little side note on the alcohol piece. I don't really drink that much. You know, be told. I like a nice glass of chardonnay, truth be told. But you know, whenever I've done a big race, I've kind of not had anything to drink at all. And so I made the decision. I'm done. You know, I'm just done. And I'm just creating little spritzers at night and all. But you know what? [00:10:02] Speaker A: I feel great. [00:10:04] Speaker B: It's kind of like when I made a decision to decrease sugar. Now everything is too sweet. It's just a matter of what we get used to, right? [00:10:12] Speaker A: Yeah. So the recommendation for women is. You're going to be shocked. Two drinks are less weak. That is the new recommendation. We used to allow up to 7 to 10 for men and women. But we do know there is a very direct link to breast cancers. Cancers. And you really need to get that message out that women are really looking at. And that doesn't even count into Michelle. How it disrupts our sleep and our metabolism and all those things that go on. And as women in the peak of our life, we love coming home and used to have a glass of wine while making dinner. Go with the girls and have a drink. I'm a tequila girl. So absolutely. We just really need to start shifting that mindset like you have. [00:10:57] Speaker B: Okay, let's talk about when someone thinks they may or maybe they don't think and they end up with having a cardiac event. So let's talk about heart attack. We have discussed that. You know, you and I previously discussed that. Men, it seems to have A little more awareness out there. And we know pretty much what they're saying symptoms are. Women tend to have different symptoms and different things. They need to be focused on. Can you talk to us a little bit about that? [00:11:32] Speaker A: So what we like to say is women are not small men. We are very unique. You know, we are biologically, hormonally, very, very unique. So they've redone what the symptoms are. Women can come in with just saying, I'm fatigued, I'm just feeling off. I'm just feeling short of breath. You know, I just don't have it in me like I used to before getting on the treadmill or whatever. And we will often just dismiss ourselves saying, I'm getting older, things are changing. But those can be symptoms of women. Yes, you can absolutely have, you know, heaviness in your chest, some heartburn sensations, maybe a bit nauseous, sweaty, radiation in your arm. Those are all valid symptoms. But we need women to know that the atypical can be typical. And the American Heart association has made new posters really trying to let the public know that those are really important symptoms for all of us. [00:12:32] Speaker B: Okay, that's good. So they're starting to. It's starting to become more public, the difference between men and women and what to look out for. So I wanted to take a minute and talk to you about my own journey through heart health. And, you know, I've got a dad with hyperlipidemia. He has arrhythmia. He was super, super healthy his whole life now. Lifelong firefighter, over 40 years, never wore the mask. I have no idea why. His lungs are in good shape. I really do not. My dad has a reputation for running into fires and saving lives. But his heart became compromised. Right, But I'm always worried about myself. So many years ago, it was now I went to bed and I woke up, my heart was beating out of control. I couldn't breathe, I was sweating, I was flipping out. And my husband actually thought I was having a heart attack. We called the paramedics, the firemen come in. I won't even talk about the pajamas I was in. But anyway, it was just rough. I got taken out. They ran all the numbers. I had a very severe person in my life, panic attack. I knew what it was linked to. I figured that out. It had to do with, it was a stress related thing and it was a death, you know, and it was actually months after that this happened. But, you know, it was just really frightening. And like, how would I have known that I was having a panic Attack. I mean, I kind of wish I hadn't been taken. They wouldn't even let me walk out of the house. Like, I actually had to get in a stretcher. It was very embarrassing. And spent a whole night there and went through a litany of tests. I was pretty young, you know, so how, what, what is it that women can be thinking about? [00:14:32] Speaker A: Yeah. First, I want to commend you for calling 911 out of hospital arrests. People don't live right. And again, we go back to that. The number one cause of death of women in the United States is cardiovascular disease. So kudos to you for calling 91 1, letting them come. There's nothing, you know, embarrassing. We are glad, we're happy to give you a good diagnosis that you're not having an acute heart attack or mi. So number one, I commend you for doing that. Don't dismiss yourself. That is the biggest message I want women to leave with today is do not dismiss yourself. We'll pull the phone out in a millisecond for a man and say, call 91 1. They gotta come. The guy's having a heart attack. Because that is the first thing that comes to mind. And how many times does EMS get sent home and it's not that? And we're just like, oh, perfect, great, the guy's not having an acute mi. So good for you, girl. You call the phone and you don't need to do that. The other thing that's really important is, you know, you probably did. You woke up, you're probably in an arrhythmia for a short bit. You were feeling palpitations, you were sweaty, all those classic signs that are of concern. And so they're going to want to take you in, make sure that you're clear and that everything's great. But you really drew in about how stress, grieving, all those things, our emotions are a massive driver in our health. Like, incredible. And it can give you arrhythmias, poor sleep, you know, it can give you ulcers, it can give you headaches. And so we can't dismiss our mental health and our emotional well being. We are holistic individuals. And so I think that's really important. I would always encourage my patients, call ems, go to er, whatever you need to do. Do not dismiss yourself. It's really, really important. [00:16:36] Speaker B: I think that's probably the best bit of advice that you could give people. So we're going to talk a little bit more about preventive measures because the whole stress management is so much easier said than done. And we know how women in particular tend to take a lot of on themselves. So before we get there, now, I want to talk about cholesterol for a moment because I had an epiphany recently, which was this. So I've had extraordinarily low cholesterol my whole life. And I was very proud of that factor, considering that with my dad, with hyperlipidemia. And it was always like in the 1-30s, like really great HDL, really low LDL. And I know the markers are different now, but in a little more than 10 years ago, and I put it together recently, all of a sudden, it shot up to over 200. I'm like, what? I didn't change. I'm a runner. I do, you know, like events. I'm very active. I work out. I'm like, what is this all about? Oh, my God. So of course, I'm in the record of having familial hyperlipidemia. Right. So fortunately, I have a fantastic cardiologist I found over the last five years, and she is. She listens to me. And I'm not on medicine, right. Because we're running a couple of other things we'll talk about. But I only very recently put together, Dr. Mia, that I was hitting perimenopause at that time. I never did before them. I even went on a diet, a. A special diet by a renowned cardiologist whose name I won't bring up because it didn't work for me. I lost eight pounds, and I'm already 100 soaking wet, and my cholesterol actually went up at the end of a year. I tried it during the pandemic, and so I was like, what on earth? So I moderated my eating to get the weight back on. And, you know, I'm. I'm holding steady at 205 or whatever it is. So talk to us a little bit about that. And you know what that may or may not mean to someone. [00:18:48] Speaker A: Yeah. So it's an excellent question. So always when we're looking at women, we want to make sure we always have a good family history. So you're right. You have a family history of dad with elevated cholesterol. So we always want to pay attention and we're really always interested as well. If your dad had a heart attack before the age of 55 or if your mom had a heart attack before the age of 60. Those are kind of trigger ages for us that we really pay attention. One in 250 people, so very, not very high stats have. Do have Elevated hereditary cholesterol. What we really want to make sure we know is when we're looking at women like you and what's going on, the current literature we do know. So when our cholesterol panelists talk about that, we have our total, we have our hdl, which H, we say high, so we that's your good cholesterol and ldl, we want low. So H and L. So L is your bad cholesterol, and that's the one that contributes to cardiovascular disease. And then you have your triglycerides. So our LDL, we want low, we want it less than 100 according to guidelines for a healthy woman like you. You know, someone who doesn't have a heart attack, doesn't have any of those things going on. But the guidelines now are less than 70. If you have a stent, you have bypass, and even less than 55. Now, when you were born, Michelle, your LDL was 50. [00:20:13] Speaker B: Wow. [00:20:13] Speaker A: I'm age, genetics, lifestyle, whatever. I saw your last labs. I won't tell everybody what they were. They're not there. And so we always want to make sure our LDL is less than 100. We do know in current literature that HDL is not necessarily cardio protective. So I know this is going to be new for you. So we always used to tell our women, hey, if you have a really strong HDL and it's super high, that's cardio protective. So maybe your HDL is in the 90s or 1/ hundreds. We're happy with 5560. We know that is not right anymore. Having a really strong hdl, really, really strong is not necessarily cardio protective. So we now do other markers. We kind of re look through the, the looking glass to say, hey, this woman needs more attention. Let's really look. Why are her factors the way they are? And I think you and I both know probably one of the massive contributors for you is you're a perimenopausal, menopausal woman, right? When that happens, when a woman is going into menopause and as estrogen goes down, your LDL will go up, your LP will go up, your triglycerides will go up, and your HDL will come down now, will level out. Once you're in menopause, menopause, and you're post menopause, and you've sat there for a while, those numbers will stabilize and they will be what they are, and then we really know what we need to tackle from there. But our estrogen is very influential in our cholesterol panel so that I could talk forever. And I won't explain any more unless you want more. But you know, it does, it does. [00:21:56] Speaker B: Impact that we are going to get big into it because I want to talk about the three big. I'm on the big three hormones. Right. And we're going to spend a lot of time on that. So the one thing was, and I was going to ask you about. So here we know. Right. And I'm with you. I believe that it's this whole menopause situation. And by the way, my viewpoint is these days and women like you give me hope, but I'm like, what is the deal? Are women just supposed to shrivel up and die after they are past their childbearing years? Like, what is the, what is going on here? But yet we know about the wisdom of grandma. And honestly, women have a lot of wisdom to contribute throughout the lives of everyone. Anyway, okay, so in 2021 it was. Right. So now I'm still trying to figure out what is going on with my cholesterol. And I listen to a lot of different things, podcasts. And that's when I heard about the CT cardiac calcium score, which is a big indicator. Mine happens to be zero. I'm very thrilled. Right. We just did another one. I'm zero again. So I'm going to run it every few years, talk to everyone about that. And is there anything else that women should be or could be thinking about to help them understand where they are today and if they could possibly be at risk? Sure. [00:23:21] Speaker A: So this coronary, it's called the coronary artery calcium score and it is a low dose ct. The radiation is equivalent to a mammogram. So I really highly recommend it to my women and I use it as another tool in my toolbox. Right. We, we're always looking at these extra tools. So if a woman came in with a breast lamp, she'd go get a mammal. Right. So let's get these coronary artery calcium scores. The struggle Michelle with it is no insurance covers it. It is not covered anywhere in the U.S. and so it is cash pay, typically around 120, $150, but well worth the, the completion of it. What they do is they shoot your heart in a CAT scan. You're literally in and out, no dye, nothing like that. And they focus on your coronary arteries to see do you have heart plaque? Hard plaque happens due to irritation, those sort of things. And then it lays down that plaque. The important part for people to know is when they get their score it should be zero. So anything above zero, you know, you have to be, pay attention because if you have something there, you're definitely going to have it in other places in your body. It doesn't just pick your heart. 0 to 11 is minimal, 11 to 100 is mild, 100 to 400 is moderate, and over 400 severe. But it can be kind of fooling for some people because it doesn't see soft plaque, it doesn't see all that stuff rolling around with our elevated cholesterol. So yes, okay, it's zero. Woohoo. We love that. Okay, we don't have hard plaque, but we still need to focus on getting that cholesterol down because I say to my patients, we're ahead of the curve, we don't have a hard plaque, let's keep it like that, but let's get that cholesterol down because again, heart disease is the number one cause of death of women. Let's not dismiss it. Let's keep rolling to where we need to go. [00:25:17] Speaker B: Okay, So I don't know what my cardiologist is going to say because as you could see, my cholesterol was up from the last time. And she hasn't seen those blood tests yet because I, I told her I just had my GP do. Do it. [00:25:30] Speaker A: I don't know how happy I saw your lab. So let's talk about that. [00:25:34] Speaker B: So she only ran those five things that you saw. Yeah. Which would be the cholesterol, the triglyceride, the HDL VLDL and the LDL cholesterol, calcium, whatever that is. Nih. [00:25:48] Speaker A: So what I run on all my women is called the LP with big letters, LP and a little A. It's called lp. So it's called lipoprotein A. And it's a new marker that we use in cardiology in the last few years. And it's a marker of risk. And so we only draw it once or twice in your life. It's not something we keep drawing, but you always want to know what your marker is. So let's say your cholesterol is. I'm going to hypothetically make it up. Your LDL is 140, you got a negative coronary artery calcium score and your LP is 200. We know you're at higher risk then because your LP little A is high and we really do want to pay attention to that LDL and push it down when you. But even though your coronary artery calcium score is normal, so encourage the women on the call, get your LP Little Age drawn. No Are you at elevated risk? The LP will drift up a little bit in menopause, but it doesn't need to keep being redrawn. It's just your marker that we're there to tackle. [00:26:51] Speaker B: Okay, very good. So I have a feeling when I upload these results to my cardiologist, she'll probably either say, we need to run more again, or she'll say, last year I ran that and I didn't know what to look for. So, anyway, more to come on that. And I will let you. And I will let everyone know what my final result was and what I plan to do about it. So now let's get on to preventive measures that will have a positive. We'll call it a positive impact on having a healthy heart. We already talked about what you said. Is the LP little A. [00:27:29] Speaker A: You got it. [00:27:30] Speaker B: Lp. Women ask someone to run this for you. So let me ask you, Dr. Mia, should. Should we have. Should women go through a cardiologist? Can they request this through their gp? What do you recommend for people? What would the baseline be that they should be looking at beyond cholesterol, which your GP runs? And how do you suggest they get those. Those markers? [00:27:55] Speaker A: Yeah, just ask your GP to run your LP and please give them forgiveness. It's not. Perhaps if they're not running it, not everyone's doing that yet. [00:28:05] Speaker B: Right. [00:28:05] Speaker A: We in cardiology are doing it because that's what we do. But we are seeing PCPs, internal medicine, other people starting to order them. They see us ordering them, so now they're ordering them. So please don't be disappointed or anything like that. It's not their fault. They're just, you know, catching up with what we're all doing. And so, yeah, absolutely, advocate for an lp. [00:28:28] Speaker B: That's great. Okay, so now we talked about when I had my panic attack. And by the way, it was kind of odd because once I had that first one, oh, I started having them. I haven't had one in many, many years because I happen to have a gp. The one that I mentioned, sadly retired. He was my GP since 1999. And although in traditional medicine, he met me all the way, you would have thought he was a holistic medicine doctor. So he really worked with me on stress management. And the only prescription I ever got from him, outside of when I needed antibiotic, was buying a book called why We Sleep in all those Years. So let's talk about stress management, because women tend to take it on, right? Men, they have a gift, like they can have a fight in a boardroom and walk out and golf with the same guy. Right. Like two hours later. Women internalize. They want to like, take care of everything. At least I do. Right. Want everyone to be okay, okay. And just have all this internal stress. And I think it's part of our caretaking thing ways. But talk to us about how people can begin to really focus on their stress management and why, why taking that time or whatever you recommend is not a luxury. But really I see it as an investment in their well being. [00:30:04] Speaker A: Yeah, it's a really great point because it's is. I call it the health hierarchy. You got to start with the basics. And so everyone really needs to go back to basics. You nailed it. Are you sleeping? If you're not sleeping and you're running on five hours of sleep every night, we know you have an early death rate. You increase weight, your cortisol levels are high. You know, all those things are going on. You need to get sleep. A woman needs to get seven to eight hours of sleep consistently in order to wake up refreshed every day and able to tackle the day. And then when we don't, we're drinking more coffee or whatever it is to keep ourselves rolling. So I can't say enough. Michelle. People need to get sleep and we really need to go back to really good sleep hygiene. Get our phones off. You know, all those things. Live in your cave. So it's dark, quiet, cool, all those things. So you're actually letting your body unwind, repair and start your day off fresh. The next thing is, is I'll go back to. We need to exercise. Exercise, reduce. Elevates all those hormones that make us feel good. Dopamine, serotonin, all that natural release. Nobody ever regrets getting exercise after they get themselves out. But we are all, you said caretakers, workaholics. So much going on, maybe commuting long distances. But I need women to really get out there and get their exercise. The recommendations is 30 minutes a day of moving your body. And I'm not saying put on your running shoes and get out there and do laps, but at least get up, have a walking thing at your desk or get up and get away from your desk and move around or, you know, park farther in the parking lot, something so you're physically generating movement. Those are really, really important. And then when I look at stress, I really like women to set intention, you know, really. Is that meditation? Is that setting intention for your day? Sending some gratitude? Sometimes when we can just send gratitude to others, we fill someone else's cup up. Can Reduce our own stress. That's well documented. You know, setting those purposeful, beautiful intentions for ourselves and those sort of things. And then I'll go back to food. Food is a real trigger. We live in a bliss society where it's a lot of sugar, salt, fat, and those can be very triggering foods with all the things that are in there, we're not sleeping again, you know, all that sort of stuff. So I really want women to go back to those basics and look at that, you know, getting sleep, exercising, meditation, eating well, watching your alcohol. All those things that do heighten those things that go out and then finding yourself an amazing support system. We all need that, buddy. We all need that person where we can feel it safe and supported and have that sounding well, because there's not a person on this podcast today that hasn't had some stress in their life. [00:33:06] Speaker B: Yep. So I would like to take a moment and talk about some of the things that you do and I do to help us go through that. Now, as you know, I own a. I'm partner in a consulting business. I've got a lot of travel involved. I've got a family. I've got my mom who lives with me and she's in hospice care. My father, who's 90 and finally seeing the pains of that up in New York. So I'm back and forth to New York all the time as well. And my. I got two daughters, so I, you know, who. Who are in their very early twenties and need. Seems like they need more attention at that time as they're navigating adulthood and, you know, becoming more independent. One of the things that I do, I'll. I'll like, let's kind of that. That's my context. Now I'll talk about how do I maintain my sanity. One thing I did because sleep was becoming an issue and I am a. I was a four to five hour a night and I was running on all cylinders, but I felt fine with it. But that is when my doctor said, I know you feel fine, but it's not fine. And I'm like, okay. So I read through that entire book. It's like a big book. It's very scientific. You would probably love it. So sleep. What do I do? I never. I have a rule. I do not bring my laptop up to stairs. Period. End of story. It does not come up. I try to be upstairs by 9 sometimes. Like last night, it was 10 maybe I'm pushing 10 30. All right. I'm not going to lie about that. But I come upstairs, my Phone gets plugged into my bathroom. I don't even look at it. I do not have it on my nightstand. I don't want it anywhere near me. I have it there because my mother, if she calls me in the night, I need to have something there, right? So the electronics are gone. I've always got fantastic books on my nightstand. I'm reading the best book right now that I'm so excited about. I absolutely love it. And it's called Thomas Jefferson's Historical Fiction. Fascinating book. The challenge I have, though, this is the truth. The challenge I have is with a really good book, I might go, oh, no, it's midnight and I'm still reading right now. I'm supposed to be in bed and. But I cool my room down. I put a. I have, like, this scarf that I put over my lamp, so it's low, but enough to read. And if I am reading a lot, this is the truth. I am not lying. If I. And I know I need to get to sleep. I pick up one of those boring business books that I cannot stand, and within 15 minutes, I'm out of my nighttime routine. Yeah. So why don't you share one of your. One of your things that you do? [00:36:00] Speaker A: Yeah. You're nailing it. I just have to give it to you, girl. You're nailing it. I hope everybody was really listening to that. Fantastic. You went from four to five to your. The queen did. You're literally a while. So for me, I am a very poor sleeper, so it's a lot of work for me. Light, sound, everything always wakes me up. And so you really struggle with it. So same thing as you. I really try to set intention to go to bed at the same time every night to set that pattern. Because your circadian rhythm is really, really important when we're trying to find that balance continually. And if we're always breaking it up, it's really hard sometimes. So I do work really, really hard on that. I do always make sure that I don't drink a lot of fluids in the evening before I go to bed because it'll wake me, have to go to the bathroom, and that will really disrupt me. So I try really hard on that as well as I really do try to avoid alcohol close to bed because it's really disruptive for me. It will wake me up, you know, at 2, 3. It'll help me go to sleep immediately. But that's not how alcohol works, and we can talk about that another time. But it does wake me up at 2 or 3, and then I have a really restless sleep. I have not mastered the cell phone girl. So it is side my bed, same as you. I have two daughters that live a thousand mil away. So I leave the ringer on for emergency. Right. But I do conscientiously try to stay away from it. And the last thing that I really would stress everybody is I keep my room really cool. I like it cool. I'd rather have a bit more blankets. We know that's well. Really works well for me is to keep the room cool. Maybe I'll cuddle up to a pillow or a blanket to give me that sensation that I'm looking for, you know, to stay warm. But those are big ones for me. And saying a prayer setting intention before I go to bed at night, being grateful for my day. [00:37:58] Speaker B: Yep. That's wonderful. I did start the in the morning. I started with the gratefulness, and that's fairly new. And actually I learned that I started doing. It's one of those things you always know but don't necessarily do and it makes a difference. But I started it with intention after I talked to your business partner and friend, Susan Sly. [00:38:23] Speaker A: Yeah. [00:38:24] Speaker B: So she gave me that. Okay. So I think that we are into a good segue point into menopause, hormones, and hrt, which I am super excited about. This part of our podcast, our discussion today. So here's the big news that I didn't never thought about before. Women spend 40% of their life in menopause. So talk to us first. I was shocked. Right. And I learned that from you. And I'm thinking through all this stuff. I'm like, oh, my gosh. I'm putting so many things together about things that have happened to me through my life. As I hit perimenopause and entering menopause, I'm like, oh, my gosh. So I thought you could first explain. You talk about the things three phases or three types of menopause. Just kind of start there to lay a foundation of what we're really talking about. [00:39:19] Speaker A: Sure. So you're right. Women spend 40% of their life during this stage. We start losing our estrogen, you know, right after those childbearing years. And then right after that, it's just continually coming down that whole time. And then it's like, you know, there we go. And so it's really important. We do know that in current data, perimenopause is occurring as young as in our 30s now. And this is very stunning for us. So we go through that perimenopause stage, then we go to menopause. And menopause. You're going to be shocked, Michelle, is one day, one day of your life that you are in menopause? Because that is the day that you have been one year without a period. And then after that you go to post menopause. Right. So it's really important that women Understand this is 40% of our life where we're going through this incredible transition and it's affecting every part of our body as we're going through. [00:40:22] Speaker B: Unbelievable. So let's talk about what is perimenopause and what is menopause? Like, what. What is that? What's the difference? [00:40:32] Speaker A: Yeah. So even in perimenopause, or stages so early perimenopause, late menopause, so early, you know, you. Maybe you're having some brain fog or maybe you're having some poor sleep. Sleep is usually a really big one because hormones affect our sleep. You may notice that your periods aren't quite regular. Regular, but they're still kind of, you know, there. Then later on in perimenopause, you may notice more symptoms coming on. Hot flashes, night sweats. You might notice your periods are a little bit farther apart now, but they're still coming. Those things are still happening. And then some of those other symptoms that are going on with that, again, could be anxiety, it could be palpitations, you know, all of those things. But it's a really long stretch. We do know that the vasomotor symptoms, so these crazy hot flashes, night sweatshirts, the average 80% of all women get them, and they last seven to 10 years for all of us, not just a phase, but what we really want women to know is you can go into menopause. I went into menopause at 32 because I had surgical menopause. I had my ovaries taken out for health reasons. I'm 58 today, so I've been menopause a long time. Hardcore menopause. We have chemo, pause. Look at all the women. We have over 5 million breast cancer survivors. They went through menopause, through chemotherapy. So lots of areas where we really need to educate people that this is a very profound stage of our life. [00:42:04] Speaker B: It's really something because for so many years. I think about my mom, who she got a newsletter. We're going to talk about the pause AI later. But. And what you do. But my mom, I forward to her and then she my newsletters and then she signed up. She read the first one and it was talking about your mission and about what has happened to women in menopause. And my mother started crying and she said, you tell these women that, yes, they are my hero because I spent years suffering in silence. People didn't talk about it. And in fact, it can be a little. I'll tell you what, five years ago, I would have been embarrassed to talk about it, and today I am happily going to talk to you a little bit later about my own journey and my markers. Right. I'm going to be part of the education and be part of the movement around. This is not embarrassing. This is about empowerment. This is our lives we're talking about and the quality of it. So talk to me about why women have historically suffered in silence, and many still do. And then let's get into some of the outcomes and what has happened as a result of that. [00:43:21] Speaker A: Yeah, it's. I want. I want women today to understand that, you know, this. This is happening everywhere, globally, and sometimes our cultures make a difference. But every woman listening to this is going to go into menopause. Some of you may choose to have children, some of you may choose not to have children, but you will all go into menopause. This is like death and taxes. There's no evading this. So we're all going to go through this phase. And I think women, it's. Sadly, when this all started happening, it was called hysteria. They all thought we were crazy. And that's why the hysterectomy, hyster, you know, all of that, that history. But they literally thought we were crazy. They pooh, poohed us. And I don't think that was necessarily intentional. What I do know is there was no research. Women were not being researched until recently. And so this is part of the problem. There's no data on women. There's no research on women. Women has all been white men. And so women are speaking up. We're demanding our rights. We're wanting to be part of the data. And so I truly believe that's part of it. Is no one really. If you look in the plethora of research and you try to find a woman's health and then you try to find perimenopause, menopause, we're like a couple pages in that huge mass of encyclopedia. So we have a lot of work to do. And that's why you and I are being such strong voices for this. [00:44:54] Speaker B: Yep, yep. So I thought before we get into hormones and then, like, where I'm at and all of that, I thought I would just go ahead and talk about my journey and what it was like, for me. And then I, you know, you can share that, what you wish and what. What you have seen and what other women have gone through. So when I first went into perimenopause, like, I was a little shocked because I thought I was a little young. And I'm. I just started having missed, you know, missed periods, right? And I'm like, well, maybe something else is going on. Nope, that's what was going on. But what I didn't know throughout the whole time period was like, I didn't know that I should be looking at markers and running blood. Like, I didn't know. I just knew this was part of my life. I'm like, okay, so then, you know, as I had less periods, I'm like, you know what? This is kind of convenient, actually. I'm past childbearing years. I accepted that. And, you know, I mean, my children were a little bit older anyway, teens. But I was a little early, like my mom. And so then, though, a few years later, I went through a long period where I could not sleep. And I was just sweating. Like, I was soaking sweat on the sheets, like, through the sheets. It was disgusting. I would get up and change my very light cotton pajamas in the night, right? Like, I would actually change and have two sets of pajamas because I couldn't stand it and take multiple showers. I'm like, what is this all about? And, you know, fortunately, I didn't have some of the. Which can be really hard. So I owned a retail store, and I had one woman that went through even harder menopause, and she would just all of a sudden start really perspiring profusely in our retail store. Like, embarrassingly for her, I didn't. But she'd go into the back room, right? So I had that going on where I couldn't sleep. And most of my. When I would get my hot flashes, they were really at night. Then what happened? So then, you know, that kind of went away. In recent years, what happened was I was like, what is going on? Like, am I supposed to just die? And I'll be, you know, I'm going to say something. I normally wouldn't even talk about the vaginal dryness and the itching. Oh, my God. I'm like, what is going on? It was unbelievable. Now I don't have, like, current state right now. So we're the same age current state. I have dryness. Okay. There. I just put that out there. I don't have a lot of itching or anything, but I will tell you that I Take cranberry pills, which changed a lot for me. Like, I started to get burning during urination and. But I didn't have a uti. I didn't have any infection. My doctor said gynecologist who just like you, I loved her Dr. Mia. She left and went into research. So I was like the next day had nothing. But she's the one that said cranberry pills. But I wasn't ready for this was all during COVID So I didn't go on to hrt. I didn't talk to her about it. And that's when she left the field. So I was like, okay, now what? These things really help, but now what? And so, you know, now 20, 25, we'll get into where I'm at. But I thought, you know, I wanted to just kind of lay the foundation of like what my history has been like. And, you know, why do people sometimes seemingly have an easier time of it than maybe others? I feel like I've had years of being kind of okay. And then I found out from it was Susan Sly. That frozen shoulder you thought that you had because of old age or whatever, like because of your active lifestyle, you're a swimmer, Michelle. It's more than likely menopause. I'm like, oh my God. And she said, you've got symptoms you don't even know. And you're about right. So I wanted to get into that a little bit because it's a very eye opening part of my journey today. [00:49:26] Speaker A: So I want to commend you. So you just nailed how this stage of our life. You nailed it. Is into that 40%. You described the earlier symptoms, which everyone just always says, hot flashes, night sweats, you know, poor sleep. But now you're describing symptoms as you're going along to later stages. Vaginal dryness, vaginal itching, musculoskeletal, then we get into cardiovascular, then we get into bone. Those are all related. This is a timeline. And we need women like you and me up here speaking, saying, this is not a three or five year deal, this is a 40% of your life deal. And those symptoms are all raveling together because your estrogen, progesterone, testosterone, all those things are changing. So you absolutely nailed it. Yeah. [00:50:19] Speaker B: Okay, so we're going to talk about, let's discuss this. The big hormones. I call them the big three. So let's talk about them because, you know, everybody knows estrogen. Estrogen, right. A lot of people don't even know that estradiol is the major estrogen. I Think you can educate us on that? But let's get into the big three. We can start with estradiol or estrogen, however you call that, and move through that, if we could. [00:50:47] Speaker A: Sure. So there's many hormones in our body, and the three that we typically talk about are those three. Estrogen, progesterone, and testosterone. You're right. Estrogen kind of comes in many forms, but three that we talk about within our system. And again, it goes back to these levels start decreasing continually, you know, after our childbearing years, and then it, you know, drives right down and goes, same thing with progesterone. Same thing. Women also need testosterone. There's no question. So we have all three. You have fsh. You have all these other hormones in our body that are really important. But what's really important for the women on this call to know is, is that testing your hormones is not required. Again, not required to diagnose yourself. That is a myth. That is a myth. And it is not required for diagnosis. Blood testing is not required for diagnosis. And I know blow your socks off on this one from talking. The problem with blood testing is it is one spot, one time, one millisecond of your life, your hormones are changing continually, just like your blood sugar, just because you get your hormones done and your provider says to you, your hormones are normal, you're not there. That's not true. So we need women to know that. So just think of your period. They change as they go up. You have your cycle. They change as you go down. So it depends when you get your hormones drawn with your irregular cycles or not. So it is not required according to the menopause society, according to anyone who's certified, blood testing is not required when we're looking at those hormones. So they are important to know, but they don't necessarily guide our diagnosis at that time. [00:52:43] Speaker B: Interesting. Okay, so I want to share my story, because I am considering hrt. I'm not considering. I want to know what to do. Right? So I talked to my doctor, whom I really, really like, and she said, okay, let's run your blood. Right? Let's see where we are. So I had a televisit call, and she's like, all right, girl. That's how she talks to me. She's really wonderful. Your estradiol, it's low, less than 5, whatever that means. Your progesterone, it's really low. Mine's less than 0.1. I don't even know what it should be. Your testosterone is less than 3. And I heard the range is like 4 to 50. She said, Even your FHS is low. Like everything is. And I'm like, oh, my God. And then she said to me, so let's talk about. You want to look at hrt, right? Yes, I do. Yes, doctor. Well, it's really better for someone a lot younger than you. And you probably should have started sooner. And I'm going. I'm getting slowly crushed. Right? You can if you want to, but you'll have to sign, you know, like this consent form we can put you on and we can just see how it goes. And I'm starting to get nervous now. I'm like, okay, I'm going to be talking to Dr. Mia soon, so why don't I. Let's just see. Okay, so send me over the stuff. This literally happened over the last week. Send me it over. Send it over to me. And I said to her, you know, wait, my gp, you know, who was I? We talked about him a little bit earlier. He said to me, talk to your gynecologist, you know, about hrt. And she said to me, he didn't prescribe it though, did he? And it's probably because of the risk. And he said to me, michelle, the risk to you. They are far, far, far underweighted compared to the benefit that you're gonna get. Like, don't even worry about it. You'll die of something else. I'll stake it. And she said, but he didn't stake it because his life on it or anything else because he didn't prescribe it. I'm like, okay. So we decided to try something natural first, which is coming in the mail. And it is hyaluronic acid based, which you and I discussed. At a minimum, I'll take that cream and put it on my face instead of somewhere else maybe. [00:55:21] Speaker A: Yeah. [00:55:21] Speaker B: And so, you know, it was kind of interesting. That was my story. And then we talked about bioidentical versus, and she's like, look, there's bioidentical. Definitely need the form for that. Definitely a lot more expensive then these FDA approved drugs that are synthetic. I don't know, better or worse. I get a little bit worried when I hear synthetic, but I don't know, I thought we could kind of. I have to believe my experience is not atypical. You just mentioned the small amount of women that are taking hormone replacement therapy. So I want you now to talk to me, Frank, about your experience, like what you have to say in response to what I just downloaded to you. [00:56:09] Speaker A: This story is over and over and it breaks my heart. So I'm going to tell you that this is what's going on. So number one, we, when we're prescribing or looking at alleviating women of suffering, let's just call it what it is, you know, we always want to know what are the symptoms of suffering that we're chasing depending upon what hormones we're looking at. Right. Sadly, in the United states, around only 5 to 6% of women are being prescribed menopause replacement therapy. This is disparaging, this is frightening. This is not the way it should be. And that is because in medicine we do not receive education on menopause. So even ob gyn, they get a very small amount of time dedicated to menopause. That is shifting and that is changing because of this loudness that is going on in our country, you know, looking at better care for us. But when we're looking at menopause replacement therapy, the majority of women are applicable to be getting prescriptions and we always want to give them the right things. So when we're looking at replacing menopause for you, that the contraindications, the flat out contraindications for menopause replacement therapy are if you have a blood clotting disorder. So if you've had a pulmonary embolism or you've got something like that. Because we know all hormones are pro thrombotic. Remember Michelle, when you got the birth control pill, they said, you remember you could get a clot. Well, it's the same for menopause replacement therapy. Unfortunately, everybody thinks this dose is way higher than it is for birth control. It's actually minusculely lower. It so much lower than the birth control pill. The other contraindications are acute liver disease, you know, having an acute heart attack. We don't give it to you for those sort of things. Or if you have estrogen sensitive cancer, because some cancers are estrogen sensitive but the majority are not. And so that's really important. Family history of breast cancer does not preclude a woman being applicable for menopause replacement therapy. We like to do it before the age of 60. That is in the guidelines. So all women up to the age of 60 can have an open book. Let's look at them. Because we don't want to give you hormones back way later in life if you haven't done it. So we like to get it done per guidelines before the age of 60. If you're going to start. This is mind blowing now, but the new literature as well so says that there's no age of discontinuation. Right. So before we used to clean everybody off, take everybody off, you know, that was my story. I had a horrific story with, you know, since 32 on that is not the current literature. The new literature coming out is telling us at the lowest possible dose for the reasons that we're treating. But there's no reason to pull women off menopause replacement therapy if it's room for them. I know. I'm mindblowing you. [00:59:15] Speaker B: Wow. [00:59:15] Speaker A: Do not want to be prescribing other alternative agents. If it's really estrogen that you need or if it's progesterone that you need. Those pieces are really important. Why are we letting women suffer? Why are we not giving them what they need? You know, I. I will go back to men. If men were low testosterone for medical reasons, and we don't let them suffer, we give them back their testosterone. And we know women are rapidly decreasing, and we know it causes brain fog and all these other things, risk of heart disease. And so to be clear, we don't prescribe it for primary prevention of cardiovascular disease or anything like that, but we do prescribe it to alleviate symptoms at the right appropriate doses. 100% girl beyond HRT. We call it MHT now. So they've shipped MHT. Okay. [01:00:09] Speaker B: Oh, yeah. [01:00:10] Speaker A: Menopause replacement therapy is what they're calling it now, hormone therapy, because everyone's getting all wigged out over hormones. So we're. They're kind of shifting terminology. So my apologies. I'm jumping around with acronyms. [01:00:23] Speaker B: Of course they are. Right. [01:00:25] Speaker A: Yeah. But it all came. And I know you're going to talk about. But there's a study that changed it all for us. [01:00:31] Speaker B: Yes. And let's get into that. [01:00:33] Speaker A: Okay. There was a study called the Women's Health Initiative Study, and it was one of the largest randomized trials on hormone replacement therapy. And do you remember when Time magazine and everybody, Vanity Fair, everybody got taken off, you know, all of their hormones, it was causing cancer, it was causing heart disease. What they discovered going back and looking, when they went back and looked at the study, the majority of those women were over 60 and 65. Well, of course they're going to have increased risk of heart disease and all these other things. They weren't looking at women in their 40s and 50s. And so all of that skewed the data. And we are paying the price for a trial that did not give us the correct information. And sadly, that's what all the practitioners are still running on unless they've gone back and re educated or attended a new conference going wow, the data was incorrect. And that's where we're currently still sitting. [01:01:27] Speaker B: You know, it was interesting to me because that study, it was 27,000 women more or less age 60 to 79 now. Why? Oh, and I thought it was very interesting that it really wasn't about menopause symptoms at all and helping women with their health. It was about chronic disease prevention. Right. So they were looking at things like fractures, colorectal cancer, breast cancer, things like that. And so my first question is why did they target that age group? That would be the first one. The follow up would be. But just because you may be in that age group, that doesn't mean that you couldn't start hrt. I don't think. Is there a time that maybe you shouldn't. So let's talk about first why they chose that age group in that, that study. [01:02:21] Speaker A: Yeah, that is a flaw in the study. So inclusion, exclusion criteria. And then we always call it, you know, what were the ramifications and what do we know? Biases. We call them biases in a study. So the study is not appropriate to women in our age bracket. Of course they're going to have heart disease. Of course they're going to have these things going on. That's part of aging. Right. And so we realize that going back the new literature that has been followed from this study actually shows estrogen alone reduces the risk of breast cancer. 40%. [01:02:57] Speaker B: Wow. [01:02:58] Speaker A: So very stunning in these studies. Now when you add in progesterone, that does change the study. It doesn't have that same effect. And we can talk about that later. Why or why not you take those. But there's a very different data now and we're doing a lot of counter catch up. [01:03:16] Speaker B: Very interesting. So let's talk about these three hormones and when someone should consider one or another or all like how do they. We'll talk about later about how you find a healthcare professional to guide you through the journey, but just kind of broad stroke it a bit like what is it like me, I'm low in everything. I'm going, oh my gosh, where do I start? [01:03:42] Speaker A: Estrogen is everywhere in your body. Your body is estrogen rich, your brain, tons of estrogen, your uterus, you know, everything. And if you're having basal motor symptoms, hot flashes, night sweats, absolutely, you need some estrogen. That's where you need to go. That is the hormone that's going to help cure that. It's not actually the decrease of estrogen that causes your body firing off, having hot flashes, and it's your hypothalamus and it's thermodygulation. There's all these intricate pieces in our body that cause that going on. Your body's vasodilating, all these things are happening. But if we can just bring your estrogen up, level you out, and we start low and we start titrating up until we can get rid of those symptoms for you. That is the most common reason why people will be on estrogen. But it is also given for bladders and, you know, all the pelvic stuff that goes on osteoporosis or for, you know, many, many different reasons. But number one, usually estrogen is given for vasomotor symptoms. Progesterone is always prescribed for a woman who has a uterus. So if you don't have a uterus, that's why your provider would not be giving you progesterone. It's to protect a woman from cancer, to help that endometrial lining. So for those pieces, because that's one of its important pieces when we are a woman. That being said, you will see women getting progesterone for sleep. So we know that progesterone is a calming effect, can help sleep, those sort of things. So women take it at night, and it's usually 100 milligrams micronized, you know, sometimes 200. But that is why you will typically see progesterone given to women. So again, uterus got to have progesterone given with the estrogen. You don't just give E. And then if you don't have a uterus, but you're a poor sleeper, you may still be getting some progesterone for those reasons and for other reasons. And then testosterone. Yeah, you nailed it. We have testosterone. We are women, but we still have testosterone. There's a lot of rigorous literature going on right now in there because people will say, oh, we'll give testosterone, improve your energy, increase your libido. You know, all those sort of things, help with your clarity in your mind. We don't have solid, solid evidence in that, but we have a lot of expert opinions and anecdotals that is telling us that it is. And we just need that literature. So when we look at testosterone, yes, we still need that. And so if you give it to women, they may say to you that they're feeling a bit more clear in their mind. They have increased energy. The libido one is a lot of work. And I would never tell a woman, if I'm giving you testosterone, your libido is going up. Because there's a lot more to libido than just taking some testosterone. Psychological partner stimul, like so much more. So we're really, really clear with women with that, you know, in that exact piece in there. [01:06:43] Speaker B: Okay, that's a great overview and I think some really good takeaways. One that I heard is it's really never too late. Women should continue consider. Right. If they're having any of these symptoms and you know, what's the right way to start. So I told you what I did, believing that it was the right way to start. But today where I'm at is I didn't feel comfortable. So what I was told was, if you want to do it, we'll do the estrogen with some progesterone and just try that to start. And I'm like, but then we decided we'll try the hyaluronic acid. Right. But I'm sitting here saying, but is that the right thing? Because it feels like it's my decision now completely. And I don't know, like, I almost feel like I'd like a little more guidance around that. And I'm not sure what to do. What would you recommend or how do you think people could start? [01:07:43] Speaker A: So I always want to empower women so they go in and they know what they want, right? Yes. So I always like to follow evidence based care. Let's make sure we're not doing hocus pocus or anything like that. If you're going to take the lead and be doing hormone replacement, let's do it where we know there's evidence and studies that we can guide your, your symptoms here. So I like prescribing the patch first. The patch is number one. It bypasses the liver. It's absorbed really steady. It's transdermal. Yeah. It can be a pain taking a patch twice a week, but it is the, you know, one really solid way of getting your estrogen. Put it where it can't be seen in your bikini. I don't know. Just figure it out. It is absolutely the best way. The next way is taking it orally. Right. So you can take, you know, estradiol and those things again, we just go back to. It does go through your liver, you know, being a little bit more clear on the side effects, those sort of things. And again, always starting at the lowest dose to get us where we need to be. Progesterone, I was telling you, is In a pill. So it's a micronized pill that you take at bedtime because that calming thing, you don't want to be taking that in the morning. And testosterone, I always like, because it's not FDA approved for women. It's very important that women know that, that we like to give it in cream. So get you to rub it on your leg and cream, you know, you want to make sure you're not transferring it to other people. I do. Michelle, I need to take this opportunity. I do not believe in pellets 100. I need people to know that they are not FDA approved. And the Menopause society and all of us who are certified are going to push you away from pellets because you're going to get a peak. You're going to get a valley. We can't take them out. I've seen a woman come into my practice, she's had a heart attack. She just had her pellets put in. I can't get those dudes out. [01:09:34] Speaker B: They're there. [01:09:35] Speaker A: Right. And the other thing is, they're always cash pay because they're not FDA approved. So you are going to pay your three, four hundred dollars, you know, every two to three, four months getting your pellets in. And so I really would like women to stay away from that as their initial treatment. It's a great money maker, but, you know, go the safe route so you can be titrating and, and doing all that while you're working on, working on your symptoms. [01:10:03] Speaker B: Very fascinating. Can we, like, this is a fascinating discussion for me because it's all eye opening. Can we talk about the difference between bioidentical versus synthetic hormones? Because I really don't know. And is one better or worse than the other? You hear bioidentical. And you know, what I thought that meant is okay, they're going to tailor something exactly to me. Right. But that's not what that means. I don't, you know, it means something very different. [01:10:33] Speaker A: Yeah. So synthetic is trying to mimic who we are as close as we can. So that would be things like the patches or, you know, the tablets. Those sort of things that are, that are approved for us, but they're trying to synthetically mimic the way we are. Like insulin. Right. Those sort of things. Nice and clean. Closest we can to us. Bioidentical. So this is a. When I first had my hysterectomy, I was on Premarin. How many of you remember? [01:11:03] Speaker B: Yes. [01:11:04] Speaker A: Pregnant horses. [01:11:06] Speaker B: Yep. [01:11:07] Speaker A: Everybody thinks this bioidentical is the better way to go. It's just that wording. Right. And so that came from pregnant horses. That's not the route we go anymore, you know, when we're looking at that. So that is the difference on that. So synthetic is fine. For some reason, that word just kind of catches people thinking, ooh, sounds synthetic. But no, it's all good. [01:11:30] Speaker B: Yeah. You know what's very interesting? Premarin. I'm like, I was never on it. Or as you know, because I haven't been on anything yet. I'm like waiting. But why people never put together prem mayor. Like they never put together this pregnant mare. A pregnant mare. It was like, ah. Anyway, okay, just kind of, Just kind of food for thought there. How can someone find then a provider? Like, where would they go? What did. What should. Where. How do they navigate that mess? It seems like it's a little bit of a mess for women today. Although getting better. To your point. [01:12:10] Speaker A: Yeah, it is a mess. Currently in the US there's one certified provider to every 30,000 women. [01:12:16] Speaker B: Women. Oh my gosh. [01:12:17] Speaker A: We are rare in the country. So what I recommend women is go to the menopause society. So menopausesociety.org go on there, look and see where you live and see can you find somebody who is certified, wrote their exam. When you go on there, you will tell who has written their exam and who has not. Because there are people in there who are very interested. They became part of the society. They're about to write their exam. But you want to look for the credentials behind their name mscp. And then you'll know that they wrote their exam and they're truly passionate. They. It's. It's a hard exam. I studied a ton for that. It was, it was not an easy breezy ability to write that exam. [01:13:00] Speaker B: So what do you think about. I live in an area that, you know, it's. It's fairly affluent. There's a lot of, you know, stuff going on around here and there are cropping up. I live in this beautiful historic district and there's this new building that opened up and it's hormone replacement therapy here. So what do you think? What's your initial reaction on these hormone replacement therapy or. Or as you call menopause replacement therapy, places that seemingly are cropping up. [01:13:33] Speaker A: So we're in a very heightened social media world right now where everyone's trying to capitalize on this disparaging cares. So number one, I'm just really wanting people to be cautious of where they're going. Are they certified? Are they truly up to guidelines or sadly, are they there to make money? Right? Are they just popping in stuff and getting you on your way? And I believe most people do come with a really good heart. They're truly trying to contribute to our women's health. But make sure you're looking them up. Who are they? You know, where did they do their exams? How long have they been in practice? You know, do we attend conferences and make sure we're up to date? Because this is not an easy field. Every woman is unique. Every woman is, you know, she comes with her own blueprint. And we got to figure you out and we got to spend the time working through that in our visit with you to see where do we go. And that's why I'm moving into the new position of Director of Hormone Health. Because we really want to give women excellent care. And so there is the option. Michelle of telehealth. I do know there's telehealth out there. Maybe there's no one in your local area. Keep looking, get into telehealth, then see if you can get someone in your state who is certified in doing this. [01:14:51] Speaker B: Okay, that's really great advice and I think a most, again, good transition for us as we talk about the amazing work that you're doing and a company that you have co founded, the PAWS at AI and Harmony. We're going to talk about Harmony. So first of all, I'd love for you to talk to everyone about what it is that you're doing and we'll start with the whole mission and vision, why this came about. [01:15:22] Speaker A: Yeah, so our mission and vision is, number one, to be the most robust platform for women anytime, anywhere, that you have the ability to log on with your mobile device or your computer and find support, find answers that are evidence based. Answers for you and for your friends and your loved ones. And so that is my mission in there. There's a second big mission, is we are, as you know, working with Arizona State University very closely and we really, really want to contribute to one of the most robust data sets for women globally. We need this data. We need to be contributing so we can change our care. And so those are some really big missions for us right now. [01:16:11] Speaker B: That's fantastic. All right, so I got to ask you this. You are lighting up LinkedIn. I see you and your partner, Susan Sly, you're growing your business, you're increasing your board members. I mean, your advisory panel is unbelievable. I can't believe your latest edition. I would like you to talk about her, but also about Just kind of what has been going on as you continue to raise awareness about the pause. [01:16:37] Speaker A: AI we are, we are on a mission. Girl, we're not sleeping, we're burning the candle. I am so proud of our board. I have to just highlight and give the shout outs to them. We have the past president of the Menopause Society, Dr. Lisa Larkin, subject matter expert. Globally we have Dr. Jennifer Burke, she's trained in longevity medicine, Sports Medicine Team USA physician for 20 years. We have Dr. Mitzi Crockover, she is the founder and CEO of the UCLA Women's Cancer. So incredible. And then we now have Dr. Adriana Kik, she is from Mayo. She just recently retired from there to go to found her own company. But she is a longevity pharmacist and specializes in genomics. Dr. Paul Arciero, 100 peer reviewed articles on women's nutrition and scientist. And we have Dr. Xiao now and she specializes in Chinese and so Eastern and western medicine. We are exploding. We have people coming to us and saying hey, but we're looking for the right people, right fit because we are serving women and we want to make sure that it's perfect. So thank you for recognizing that. [01:17:52] Speaker B: Okay, so now we're going to talk about what it is and I'm just going to show you I've got it here on my mobile phone and I'll tell you harmony and what you've got going on there. It's simple, it's easy and it's inspirational. But I would love for you to talk about what it is and what it can do for women every day and today. [01:18:12] Speaker A: That's awesome. I'm so honored and excited to talk about it. So the pause is a platform and we began started out as an application on a phone so you can download an application on your phone and when you download it, what's really unique about us, Michelle, we already discussed is you get to put in what's going on within your body and we will tell you what stage of menopause you're in because there's not just one stage as we looked at. This is very unique. There's no other application out there that does that. And then once you get into, you get to identify, you get to create your own avatar because I want you to work really well with it versus feeling shy and not one. I don't want to say I'm Dr. Me attorney, I got vaginal dryness and brain fog and I just wrote your prescription yesterday. Right. So we allow women to really engage in the platform in an authentication way when you get in there, it is amazing. We have all these news articles that keep you up to date on what's going on. Then we have challenges and we brought in challenges because it's really important. Decreasing your alcohol challenge, increasing your exercise challenge. Our sleep challenge starts July 1 because sleep is pivotal in there. Then when you're in there, what I love is you can attach to your wearables. So I've worn a wearable for five years because of my heart condition. But I get to attach it to my app and every day I get a resilience score. So it counts all my biometrics and it tells me what's my resilience score. Okay, do you want to know what it is? [01:19:50] Speaker B: I do want to know. [01:19:52] Speaker A: I was up last night. I was in a meeting till 12.10pm last night. [01:19:57] Speaker B: No good? [01:19:58] Speaker A: Yeah. So it's saying, girl, you didn't get enough sleep, you're up. [01:20:01] Speaker B: Here you go. [01:20:02] Speaker A: So my resilience store is 29% giving me some suggestions, but it picked it right off. Things it does is it makes us do gratitude, it makes us, you know, drink our water, all those pieces. But what I really love is, let's get right to it. It has harmony. So harmony. We are the only platform out there where a woman can have an AI agent there for her anytime, anywhere. You can ask her at 2 in the morning, I'm having a hot flash, what do I do? Or I'm extremely depressed or what is my ldl. It's all evidence based. Menopause society guidelines are in there. Cardiovascular guidelines are in there. I want you to think of it like your practitioner. But we're not a practitioner. But we're there through artificial intelligence and that is extremely unique for us. We have meditations in there. We have all that. You track your symptoms. There's a lot of updates coming up. Also Michelle, we are going to have full nutrition app in there in July. So protein pacing because women need to be increasing their protein massively during this stage. And so we're going to have that in there for them calculating. But what we are so excited about is we're going into the benefits section now with organizations and city of Phoenix, Mesa pd, asu, you know, we have all these organizations that were going to go in and improve the wellness of women globally at a larger scale. And they get a big organizational dashboard to help their women truly feel seen, heard, improve their symptoms. And again, all anonymized. Right, all of that. But we are going to be conducting clinical research trials with Arizona State University. This again, never done before. So excited because we're contributing to data and the wellness of women, and this is cutting edge for us. [01:22:01] Speaker B: All right, so I want to ask you something that I ask all of my guests. As you know, we are riding the big Wheel. It goes back to my childhood memory of when I was on an AI panel. They said to me what was one of my favorite childhood moments and why? And it was riding my big Wheel, and I had a clear sense of independent. It was a little scary. I was taking the turns. I'd peel out on gravel, or so it felt, and I'd get up and go at it all over again. And to me, as I was thinking through my podcast, that is how I describe women in leadership and women in their own journey. So I would love for you to talk to us about a bigwill moment for you. [01:22:44] Speaker A: So my big will moment is quite recent. So a year and a half ago, I was at home, and I was making coffee, and all of a sudden, I felt like I was going to black out and pass out at home. And I called my husband at work and said, you need to come home. I'm in the kitchen. I think I'm going to go down. And he called the neighbor, who then called ems. And they arrived at my house. I'd gotten myself to my bed again, this is a year and a half ago, And I was in my bed. EMS came running up. They did my 12 lead, and it was normal. So 12 leads or ECG. And he humiliated me and handed it to me and said, your 12 lead is normal. And he said, read it. And I read it, and it was normal. He says, do you have substance abuse? Do you have anxiety? Do you have depression? And I was humiliated. Michelle. They wanted to port me to the hospital, so I went. They gave me in on Dance o Tron, which is for nausea. And I got there, my husband followed in behind, and I said to my husband, I'm leaving. This was so dismissal for me. So I had a flannel, I walked out. I pulled my IV out at home, and I got home, and a week later, I was in the clinic with my colleagues. And I said to them, I don't feel right. And they listened. And they were like, your heart's irregular. And they put a Holter monitor on me for a week. And when the report came back, it was like, oh, my goodness. I had this big run of this really bad rhythm that would cause you to want to blackout, go down. So the rhythm that I had at 32 was still here with me, me being in health care. This is 25 years later, women are still being dismissed. We are not getting adequate care. And my heart is. That's my Big Wheel moment. I'm on a mission, and I continue to be on a mission to advocate for women, for education. Here I am in cardiology, sitting there and getting dismissed, asking if I have anxiety or substance abuse problems, only to have my colleagues diagnose me in my clinic a week later. And so I am not going to stop, Michelle. I'm going to continue to do what I do. That's why I don't retire. I keep riding it going. We have a lot of work to do. So whether I was 32 or 58, I'm still dismissed. And that is not okay. And now you know why I said to you, kudos to you for calling the ambulance. [01:25:21] Speaker B: Wow, that's just amazing. And I just so congratulate you on that. It is changing rapidly, meaning that you're getting a lot of attention globally on this. I see that you've increased your board members who are on there. You've got an amazing team surrounding you. And I think, you know, we're just at the beginning, just at the very beginning of what you're going to be doing. So I would love for you to talk to people about, you know, how can they find out more about this? Dr. Mia I think it's amazing. Like, do you. How do you want people to connect with you? How can they connect with the paws? I think it's just such a wonderful opportunity. And truly what you and you and your partner are doing on this, I think is just an amazing, amazing tribute to women and to your dedication to them. And I just, I just am very dedicated to you as well. [01:26:25] Speaker A: Thank you. I'm really grateful to Susan Sly, you know, the founder and CEO. We're working together in tandem. We are a female founded company and this is Grind, right? We won Arizona Inno Awards last week as the top female founders for the state of Arizona. And we're truly really wanting to make a difference. So for the viewers on here, go to the paws. AI if you want to go on our website, you can go on the Apple Store. You can go into the Android PlayStation Store store in there. You can check me out on Instagram. Dr. Mia Chorny is where you'll find me on there. I finally started a public Insta. I was a little resistant. [01:27:06] Speaker B: Oh, look at you. [01:27:07] Speaker A: So it is new, just like you were saying. So it's pretty fresh. But I did do it. And so I really would love women. You know, we have a. We also have a private Facebook group. Join us. We have over 1700 women now in our private Facebook group. We just held a sleep webinar last night. I put it together with four subject matter experts across the country, and we did a free panel and education for an hour. We're always doing things like that, you know, and we're here, truly, of advocates of women trying to make a difference. [01:27:41] Speaker B: Well, thank you. Thank you for what you're doing for women globally. And there's so much more to come. Thank you so much for being here with me and for sharing so much wisdom and insight. And I am very excited for the next time we talk because I'm sure that you will be back. [01:27:59] Speaker A: Thank you. Thank you so much. It's been such an honor, truly. [01:28:05] Speaker B: Hey, it's Michelle. Thank you so much for listening today. If you enjoy our podcast and know someone who you believe would make a great guest, I would love to hear from you. Feel free to connect with me on LinkedIn and let's talk Talk. I'd love to hear your feedback. And as always, may it inspire you in your own personal and professional journey of life. Run toward the unknown. When you're riding the big wheel, you're not alone.