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EP: 10: Changing the narrative for the future of female health

Dr. Javaid, MD and Board Certified OBGYN is an entrepreneur and expert advocate for women’s health. Her own personal journey has inspired her to become the  founder and chief medical officer of her practice, Her MD. At Her MD, they providing women with comprehensive health care. At Her MD, they take a female-focused approach to health and wellness, and are revolutionizing the experience of health care. Dr. Javaid and her team incorporate everything from cutting-edge technology along with creating a calming, comfortable ambiance for their patients. 

When it comes to female health, we are finally scratching the surface, yet we have a long way to go. Through the work of people like Dr. Javaid and her team, they are changing the narrative, pushing through boundaries and providing education to women world wide.

SHOWNOTES: Podcast site wellnessessentialspodcast.com | instagram.com/checkablemedical | Checkable site checkablemedical.com | Dr. Javaid Her MD site hermdhealth.com

Full Transcript:

0:00:01.1 S1: In medicine, you don't get that training on how to interact with people, you learn the science, you learn the data, and that's it, and that's what's different, whether you're answering phones at Her MD, you're greeting people at the front, the medical assistants, the nurses. We have continual training on patient interaction, patient satisfaction, and what women are looking for.

0:00:23.5 S2: Hey, this is the Wellness Essentials Podcast. WE for short. The WE Podcast is all things health and wellness. A place where women like you can come to be their authentic self and be a part of a community that supports them in their health journey in every stage of life. This is the podcast for engaging health and wellness entertainment with actionable steps you can take into your everyday life. No topic is off limits when it comes to health and women's lifestyle. Let's face it, being a woman comes with all sorts of fun. Hear real, raw conversations and teachings from experts and everyday women who have been in your shoes and get inspired to make things happen, and have the tools to do so. This is the WE Podcast. Hi, everyone, this is Patty Post, your host of the Eellness Essentials Podcast. And today, I have Lora Larson as my co-host. Where today, our guest is Dr. Javaid. Dr. Javaid is a board-certified OB-GYN, and she is a sexual health specialist. She has her own practice in Cincinnati, Ohio, and she's quite the entrepreneur expert in women's health and advocate for women's health as well.

0:01:59.4 S2: Thank you for being a guest today, Dr. Javaid.

0:02:02.6 S1: So excited to be here.

0:02:04.5 S2: Awesome, so I've listened, we've listened to a lot of your different podcasts and you have a phenomenal story. Every entrepreneur, and I think everyone has their own testimony, wondering if you can share your testimony of why you are in the position you are today.

0:02:23.1 S1: Yeah, don't all entrepreneur stories start with a very personal one, right? That kind of shocks you and changes you forever and molds what you're gonna do and gives you life, direction and purpose. I was pre-med at the time, so that was already written for me, but my mother became gravely ill when she was only 45 years old, and it's not because she didn't have access or insurance, she went to doctor after doctor complaining of left arm pain, shortness of breath, chest pain, and they kept just patting her on the back saying, Oh, you're too stressed out with your children, cut back on your caffeine, she ended up having emergent quadruple bypass surgery, and lucky for all of us, she's still alive and well to this day, but it left such an imprint on me, and at that point in my life, nearly losing my mother at that age, I decided that female healthcare was not where it needed to be, that I was gonna be an advocate and a champion for women, and went on to go to medical school and do my OBGYN residency, and the current system of our healthcare... The status of our healthcare, especially for women, smacked me in my face. I was seeing 50 patients a day, I didn’t have time to eat or go to the bathroom, let alone be an advocate, and for that reason, I bought a building and started a practice called Her MD, really creating the environment that I wanted and that patients needed, and so that was the birth story of Her MD.

0:03:56.4 S2: Wow, amazing that your mother is still alive today, and I bet she is incredibly proud of you for what you've accomplished and digging in and really taking that story and seeing it through to help others.

0:04:09.4 S1: I think she's so happy, she always says, if women don't have to go through what she went through, that even if we've made that change for one person, that she would be so happy because she was so traumatized by... Basically, I did a TED Talk about this. I call women invisible patients, not seen, they're not heard, they're dismissed. There's article after article that our mortality rates are higher because we don't get the healthcare that we need, and it's not because we're not seeking it out. It's because we're being dismissed.

0:04:41.7 S2: Even in clinical research, that it's not women who are participating in trials, it's men who will consent, they'll engage in the trial and then they fall out after one or two visits, and it's like you would think that the system would realize, Hey, we need to study... Women are really good at following through in their study too, they don't drop out, but also women, our anatomy is obviously completely different than men, and we need to have more... I think that we need to have more of an understanding and emphasis on that in clinical research...

0:05:21.3 S1: Yeah, women are currently under-represented in three out of every four clinical trials. That is still going on in 2022, and so at Her MD, we do perform clinical trials every year. My goal is to do even more. It's the only way we're gonna get data, we're gonna understand how women respond differently to medications to surgeries, and honestly, it's the data that we need to get insurance approvals, right? Everything is considered experimental until we have research, and once we have that research, then we can move that needle as well, to get much-needed medications and surgeries and procedures covered for our female patients...

0:06:01.5 S2: It's amazing, good for you. And are you publishing them and getting on the podium and posters after PI?

0:06:11.8 S1: Yeah, so we did some research with our CO2 laser, looking at a very painful dermatological condition that women can get, and this year we're presenting some data on a sexual health medication, looking at a couple of hundred patients, so it's gonna be great and looking at that drug, Addyi, in very unique populations, menopausal patients and cancer patients, and so currently the goal is, I just submitted to five different conferences and the goal is yes, to get that published as well, and then I'm starting a Botox trial looking at Botox and all of the clinical applications in sexual health. Wow.

0:06:49.2 S2: That is... See, you're an... You're so creative. That's amazing. Are you able to discuss that with different ways that it could be... Botox can be used in sexual health?

0:07:01.1 S1: Oh yeah, so Botox initially, just a few years ago, the only data was out of Egypt and just very recently, there's been a few papers in the United States, but at Her MD, we've been using it for seven years successfully for a condition called vaginismus, which is the involuntary contraction of the muscles around the vaginal opening, which can render sex impossible, even in the exam or tampon use impossible. It's a very, very painful, difficult condition to live with, and it wrecks lives and at Her MD, I inject the muscles around the vaginal opening, which paralyzes the muscles, just like when you get Botox in your face, and it allows women to use tampons to have an exam and most importantly, to have intercourse. Just this morning, I found out one of my patients, who's a success story, she's now pregnant, she was never able to have intercourse, she had the procedure with us, and then I just found out this morning she's pregnant and she was like, Dr. Javaid, intercourse wasn't even on the menu for us, and now I'm gonna be a mom. And so of course, everyone in the office is beside themselves with happiness.

0:08:05.0 S1: So that's one of the major applications. There's also a condition called vestibulodinia, our vestibule is all that tissue inside the labia minora, so right at that opening, we can inject Botox there to help women who are having that pain. And then there's a very rare condition that we see a lot of that Her MD is called persistent genital arousal disorder. It's like a nerve disorder, it causes immense pain, and this feeling of continually feeling like you need to orgasm, but orgasm doesn't resolve it, and it actually is very, very painful and very distressing. There's high levels of anxiety and depression with this condition, and so just a few Botox units around the clitoris, and we can markedly help patients with that as well, so I'm collecting all of this data, telling people how we do things at Her MD so that other women around the country can also be helped.

0:08:57.0 S2: And bringing awareness to some of these conditions has to be the most important way that women can then seek treatment, because if you live with something, living with pain, you don't need to be living with pain, go speak with your doctor, do your research, how many other physicians are doing what you're doing, do you have...a good sense of that?

0:09:21.5 S1: I don't, unfortunately, in medical school and residency, we don't get trained on sexual dysfunction, you learn how to help someone get pregnant, how to help someone avoid pregnancy, and how to treat STIs or sexually transmitted infections. No one teaches you about orgasm, sexual pain, arousal, desire. So there's an organization called ISSWSH, the International Society for the Study of Women's Sexual Health, that trains us. It's not the vast majority of OB-GYNs though. It's why oftentimes I'm someone's eighth or ninth doctor. Patients can go to that site though, and there's a physician locator button and they can try to find physicians who are trained. The other biggest barrier, though, to getting this type of healthcare is most of the physicians who practice this type of medicine do not take insurance like we do, because it's cost prohibitive, but we figured out a way at Her MD to make it work. And so we do take insurance, and that's why we've gotten patients from over 32 states, and we've had patients travel to us from Canada and the UK. Wow.

0:10:25.3 S2: That's incredible. Because that is a barrier to getting any sort of care... You don't have the reimbursement. And then you live with it. Right.

0:10:35.9 S1: So at Her MD, how is the patient experience different from going to your typical OB-GYN, how have you change it to make it... For women, by women. So first of all, everyone is trained in giving everyone the best experience in the world, so you'll notice right when you walk in there’s chandeliers, there's real furniture, there's real paint colors, it's a beautiful space. Like women will walk in and say, Oh my God, I'm sorry, I was looking for the doctor's office. We're like, Come on in... This is the doctor's office. And then in medicine, you don't get that training on how to interact with people; you learn the science, you learn the data and that's it, and that's what's different. Whether you're answering phones at Her MD, you're greeting people at the front, the medical assistants, the nurses, we have continual training on patient interaction, patient satisfaction, and what women are looking for. We have robes, we have socks, the rooms are beautiful, we have temperature control, so you're not freezing. How many of us have been freezing at the gynecologist, you're half dressed, you’re frozen. Lighting... I paid very close attention to lighting, just like you don't want horrible lighting when you're going in an trying dresses, nobody wants horrible lighting when you already feel exposed, and so those are the ways we made the entire experience different, and I would say I've been practicing for 20 years, I know what bothers me.

0:12:01.5 S1: And then just listening to women for 20 years, they'll tell you, I hate this, I don't like this. This makes it worse. Our speculums are different, they come in all different sizes. Our patients don't have to get weighed, we don't use metal speculumd, we use plastic ones, they're a lot more comfortable. And so those are all the ways we've made it as comfortable as it can be to go to the gynecologist. Amazing. So one of the things I saw on your website was you guys specialize in sexual health, sexual dysfunction, how did you realize it was such a big problem for women, and how did you get the knowledge and training to help women through those dysfunctions? Yeah, so I was in a very traditional practice, and I got very frustrated when I had patients coming to me saying, I don't have sex drive anymore, and I'm gonna lose my marriage. I survived cancer and I'm so excited, but now it hurts every time I try to be intimate with my partner. And my heart was broken, and I was so frustrated that as a provider, I had nothing to offer them, I hadn't been taught anything.

0:13:13.0 S1: So it was his patient stories and the promise I had made to myself and to my mother to be better, and so I got involved with ISSWSH -that organization I talked about, I went and got all the additional training, I did some preceptorships with some of the gurus in sexual health in the country, and then started practicing this type of medicine and then developed my algorithms of care, and so now Her MD has two locations. And our goal is to have 15 by the end of 2023, and so just teaching other providers opening other locations so that all women can have access to this type of healthcare. So it was really a patient-driven, and then I saw the gap in medicine that... No one was doing this or doing it correctly, and then learning it and then bringing it back and then teaching others. Let's talk a little bit about low libido. I know that as a woman myself in marriage, I feel like they want it a lot, and I rarely feel like I want it. How do we know if it's a normal thing, if we wanna use the word normal or not, I'm not sure, or when is something that you should be looking for a supplement for, are looking for treatment for...

0:14:29.2 S1: When do you know if it's just “meh” or low libido that you need you medical attention for? Obviously, it's a patient's right to say yes or no, right, and there are gonna be times where it's very typical that you're not in the mood, you have a newborn baby, you just had surgery, and there are times where you just don't want to... And that's okay. So when low libido actually becomes a medical condition, it's called hypo-active sexual desire disorder, mouthful, HS-DD, about 1 and 10 women suffer from it. And what are the key diagnostic components, or how do you know that it is that and just not...that you're not in the mood. And so the definitions are that you had desire at one point that you consider normal or typical, your low desire has been going on for six months or greater, it's not directly due to another medical condition or a life condition, like I mentioned, if you have a new baby and you have low libido, I'm not gonna diagnose you with HS-DD. The fourth component of that definition is that it's bothersome to you. If I have a patient who's like, I'm done with sex, it's not part of my life anymore, I'm okay with that.

0:15:38.4 S1: My husband has problems too, we’re very intimate in other ways, I'm not chasing her down with medicine or options. That's fine. That's where she's at. So if those four data points are there, then we make the diagnosis, and the amazing thing now is that we have two FDA-approved medications and another hormonal option that actually is proven to help women with low libido if they so desire. And two of the medications work on neurochemistry in the brain... Fascinating. Basically to increase excitation, so the things that say yes, and decrease inhibition, or the things that say no. And so my cancer patients, my women who can't be on hormones, they’re candidates for these medications. Typically insurance will cover them now, sometimes they don't, but women have those two options, one is called Addyi, it's a nightly medication, you take it every night regardless, so it's not like female Viagra where it's on demand. And the second option is an on-demand and it's called by Vyleesi and it's an injectable that about 45 minutes later, kinda like Viagra, you have increased desire. So those are two really nice options, and then testosterone is a hormone that we all on this podcast make, it's in our ovaries, and it supports all the domains of sexuality.

0:16:56.0 S1: So what do I mean by that? Orgasm, desire, arousal, pain, lubrication, so all the ways that sexual health providers like me, we break down sex when we're talking about it in a healthcare setting, and so testosterone supports all those domains. And we can give women testosterone as well if they didn't wanna try one of those other medications. And people ask me why the brain... What does that have to do with it? And how did people prove that? So they took women who are struggling with HS-DD and those that weren't, they showed everyone erotica, i.e. porn, and then put them in PET scanners and saw the exact opposite pattern in the brain for women who were struggling, they had really, really low excitation and really high inhibition, and the opposite pattern in women who weren't... And so that's how these drugs came about as to where to target... It is pretty fascinating science...

0:17:51.7 S2: A question that I have about the testosterone, if we are experiencing low libido and we wanna talk with our medical provider, or even if we wanna walk into a Quest and ask for a panel of bloodwork, is that something that is diagnosed via blood or do you just say, Oh yeah, let's inject one testosterone pellet and see how it goes? What do you find is the best way?

0:18:21.9 S1: So never ever, ever do I ever give anyone testosterone until I know what their baseline levels are, and so testosterone panels are available at Labcorp, Quest, you need an order from a physician, I do not recommend spit testing or urine testing... Serum is the most accurate, and it needs to be ordered by a provider, and then we check your total testosterone, your free testosterone, and then based on that, a provider can tell you, yes, you need it, or No, you don't... And then prescribe accordingly. Now currently, the FDA has no testosterone-only treatment option that is approved for women, so your provider can either compound a cream, Patty, you mentioned that there are pellets or male formulations are available. I typically stay away from those, they tend to be the most expensive and they're the most difficult to titrate for women, but testosterone formulations are available for women. Great.

0:19:21.0 S2: I have heard a story of a woman that she had gotten a pellet and it was too much, and she says she felt like a silver-backed gorilla and she had to get it removed. So that has made me be like, Oh gosh, I don't wanna get that, but it depends on how the testosterone is delivered.

0:19:40.7 S1: Absolutely. And that it's done correctly. I tell people to be very wary of pop-up hormone shops that don't have providers there, that aren't checking levels... It's very scary to me. Testosterone is a wonderful thing. There was a consensus statement that came out a, testosterone global consensus statement stating that testosterone is indeed safe as long as levels are followed as long as you're seeing a provider, but aside from acne and hair growth, if you get too much testosterone, you can have personality changes, you can have blood clots, so that's why I am a stickler, and those of us who practice it a medicine appropriately, you have to check levels and then you follow patients’ levels once you've given the medication, 'cause you wanna see, Oh, they started here, I got them to here. Make sure you didn't prescribe the wrong dose, 'cause sometimes there's a little bit of adjusting, a little bit of magic that goes on, and when you're trying to get patients to that goal level.

0:20:36.0 S2: I had some bloodwork done for life insurance and I found out that I was well in my creatine, which was very surprising to me, and then my protein, and I take protein shakes, but I'm not very regular on them, and I have two teenage boys and they're all about creatine and building muscle mass, and so that was one thing that I asked my doctor, Should I be taking creatine a couple of times, and I now take it twice a week, and I actually have seen my... I'm not as tired in the afternoon, and I wonder if that was making me tired was my low creatine and protein.

0:21:15.0 S1: Potentially... Yeah, yeah, sometimes there's multiple factors that can lead to fatigue for women, but potentially, especially if you're feeling better.

0:21:25.7 S2: I'm glad about it. The team at Checkable Medical is famously fussy about what goes into their bodies. Otimal health at every stage, in every age is key to living a life you love. Better supplements and superior ingredients in simple, easy to absorb formats that fit into your daily life. Feel your best with Checkable Wellness. If you're ready to get started, check out checkablewellness.com for more details. Your healthcare begins at home. So I've been reading a lot about the pH of the vagina, and that really is... When it's out of balance that it can really be disruptive, and I look at it, it was something that I had really never heard about, and I remember my mom talking... She had yeast infections a lot when I was growing up, and now I'm looking back and when we talk about it, I'm like, Well, you were going through menopause, and she had me at 40, so I'm able to remember her in her early 50s going through menopause, and she's like, oh, it was crazy. And now she's kind of telling me about the symptoms, and it's almost like she's opening this world to me that I had no clue that a woman ends up going through, and then I have an 11-year-old daughter where now she's coming into womanhood, so it's like I'm on the front end with her and then myself going into the stage of menopause, and it seems like the seasons of your vagina, and what is the pH balance of your vagina and should we be testing...

0:23:08.6 S2: If we have symptoms?

0:23:10.7 S1: So yeah, the pH of the vagina, the vagina is first of all, and not...your outside, right? That's your vulva, your labia minora and majora. It's the canal, and the pH of the vagina tends to be acidic, so more acid-based, and why is that? That's to protect us from pathogenic bacteria, or the bacteria that can cause vaginitis or infection, or burning or itching or discharge, so the vagina tends to be a very acidic environment and that's to protect us so that those bacteria we don't want in there, they won’t harbor, grow and multiply. And so, yes, if patients have burning, itching, foul odor or discharge, I do recommend they get tested... Now, we typically don't test pH, we know the pH gets altered when there is an infection, but providers, we typically want to know what infection it is because then we can target with the right cream, antibiotic, whatever we need to do. And to answer the second part of your question, yes, as we age, so if you think about the vagina like an accordion that has these nice deep folds, so we can stretch and accommodate our partner, as we go into menopause and perimenopause, there’s something called genitourinary syndrome of menopause, and so the vagina tends to start thinning because there's not enough estrogen and testosterone around, and so then we become more like a tube sock and we can't stretch, and so we get that burning, that pain and that increased propensity to have infections.

0:24:48.1 S1: And so that's what starts to happen as we go into menopause, so definitely there are ages of your... I like that, ages of your vagina for sure, but the beautiful thing, Patty and Lora, are there things that you can do about it to treat it, you're just not doomed to having painful sex and vaginal infections all the time, So...vaginal suppositories, localized hormones, vaginal moisturizers, you gotta take care of your vagina, just like you do your face, your hands, anything else, and you can help support a normal pH of your vagina. The other thing you can do are probiotics, if you're not great about your diet, there's a couple of great companies, My Happy V is one of them, they sell great vaginal probiotics, Good Clean Love is another one. These are companies that have done their due diligence and make good products that are targeted towards the GYN tract. I tell my patients don't get a generic probiotic because you might be taking the wrong bacteria, we have different bacteria in gut than our vagina... So picking the right product is very important, there's some crazy products out there, I had a patient a couple of weeks ago bring me something and it was called Happy Hoo-Ha Cream, I think.

0:26:01.8 S1: I was like, Oh my God. And I asked her, Walgreens is selling something called... I think it's Happy Hoo-Ha Cream. I was like, No, you do want Happy Hoo-Ha Cream, OK? These are good companies. But you know, this is what is out there right now, and it's gotta be incredibly frustrating, I'm sure, for patients when they're trying to find something and it's at Walgreens, so you're like, Okay, this is great. No, it's not.

0:26:28.5 S2: The branding. I would love to hear what they did, throwing the names around for that product.

0:26:37.4 S1: I'm willing to bet there was not a female marketer or a researcher in that room.

0:26:44.3 S2: I'm glad you said it. That's what I was thinking. I was in clinical research in medical devices before that, and I was in Minneapolis, which there's a lot of companies that are devices to treat the prostate, and I always said there is no... It seemed to me that there is no organ that is more researched and well-funded than the prostate, and it seemed to me, and being in that area that there was an extensive amount of research and an extensive amount of medical innovation around the prostate, which I'm not saying there shouldn't be. But I really appreciate that you're saying the pendulum needs to swing or we need to have the equal amount of dollars and research spent in women's health, because there’s so much, I think of the slings and the vaginal meshes and those products that were very damaging to women and now it seemed like all the research really pulled back because there were such repercussions in women's lives because they were damaging. So I appreciate that what you're doing.

0:28:00.1 S1: You saw that article then, 'cause you were in Forbes that referred to the prostate research, so the prostate is about the size of a walnut, and I believe it was 2018, but received 2% of all healthcare dollars, which is a lot considering the size of the prostate, and I'm not saying that men don't deserve their research dollars, but women head-to-toe, breast, brain, eyes, heart, ovaries, uterus, vagina received 4%. So if you think about that, that's staggering, that the research dollars... And I think about all the penile implants that are out there and everything, and then these lasers that we've got going on, vaginal lasers that we use in our office all the time for sexual pain, for dryness, for incontinence, they're not covered by insurance right now, and it's because we don't have these multi-million dollar trials that prove that it works and people are running around calling it vaginal rejuvenation when... Yes, it does that, but it does so much more. There's so many clinical applications, and so that's why we were dedicated to getting some research down for some of these CO2 lasers, but it's really, really cost-prohibitive, and it's really hard without a very large grant to get the type of numbers you need to truly move the needle with the FDA.

0:29:22.8 S2: Oh, we understand. We're working with NIH, an SBIR, and if you don't come out of an academic center, it makes it even more challenging. Once we are at the point where we are through our clinical trial for our at-home strep test, I really want to put an emphasis on the government to say, You gotta look at private businesses as an opportunity to innovate because it can't just come out of academia, there's too many layers, they're too slow, the innovation isn't getting into the hands of physicians, and more importantly, it's not benefiting patients or your patients because of that slow process, so I'm with you. Maybe we'll some day have an opportunity to talk with FDA about that and do something to help private companies and physicians that are making a difference, or... Dr. Javaid, do you have a lot of practical advice for women, and it sounds like you practice a very healthy way of living as well, is very interested in how you practice... You mentioned intermittent fasting in one of the interviews that I heard, and how that benefits women, and Lora and I are in our office together, and I'm intermittent fasting, I'm on week four of that, and Lora is keto.

0:30:41.5 S2: So we both are trying to do our thing, and we rely on some apps and we look at recipes, and unfortunately, you wish that after Lora is almost two months now, you wish that you'd be like, Oh, I'm this entirely new person, you feel good, but you don't necessarily look dramatically different and we end up falling out of a routine. Wondering if you can share the benefits besides just the physical benefits of routines, whether it be keto, intermittent fasting.

0:31:12.9 S1: Yeah, so I'm a big, big proponent of things that are not fad, things that are sustainable, and things that are easy. And intermittent fasting, I started a few years ago, I'm married to a cancer doctor, and we both became huge fans because high insulin levels not only lead to an increased risk of diabetes because you can only make so much insulin in your lifetime and insulin is released, so we can clear sugar out of our bloodstream, so we don't become diabetic and then we store that sugar as fat, and so high insulin levels are not great 'cause eventually our body cannot make any more, and then high insulin levels are also associated with risk of cardiovascular disease and also a lot of cancers, specifically GI cancers. And so how do you bring insulin levels down?  Intermittent fasting is a nice natural way to do it, 'cause there are medicines obviously, and so intermittent fasting brings down that insulin level, which decreases your risk of diabetes, cardiovascular disease and cancers. And so I recommend anywhere from 12 to 16 hours for patients, obviously, depending on what life stage they're in, and whether or not they've got young children, whether they're perimenopausal and menopausal, and the reason I like intermittent fasting is it’s sustainable, it doesn't have to be done seven days a week, and it also targets belly fat, and so that is what I like about it, it's where women complain to me the most about, Hey, I don't like this anymore, when I gain weight, it doesn't go to my breasts and hips, it goes to my abdomen, and so I like that.

0:32:51.9 S1: Obviously, I love cutting the risk of cancer, diabetes, cardiovascular disease, 'cause that's important to me, but it's sustainable 'cause people can take the weekends off, they can do it during the week, and it also eliminates those carb cravings and that kind of carb coma that people get into and that 3 pm, I wanna Snickers bar. I personally have tried keto myself, I have familial hypercholesterolemia, it's why my mom got sick, and so keto is not a good option for someone like me, and that's why I always tell people, talk to your provider first, I also think keto is very hard, if you're talking about 20, 30, 40 years, it's a hard diet to sustain, and so once you lose the weight from keto, the biggest next question from patients is well, how do I maintain this? I can't stay on keto forever, I don't want to stay on keto forever, and that's where people get into the weight gain again, and so... I have tried keto, not a good option for me. It's good for weight loss, but you gotta talk about maintenance and sustainability.

0:33:59.0 S2: Yeah, I think the hardest thing coming out of keto, 'cause I've done it before too, and sustaining that vegetable intake, 'cause you're like...you get off keto like, I'm just gonna do whatever I want now, and remember half a plat needs to be vegetables still and I would agree, keto is not for everybody.

0:34:18.3 S1: And you have to move. That's the other thing, it's weight loss and success, and the people who maintain are people who not only change their lifestyle, but they also add a lot of movement to it, right. To keep your calories in, calories out and just your metabolism where it should be, and so movement is key. Hydration is key. Really keeps us healthy.

0:34:42.5 S2: Absolutely. Hydration. Don't want the dry mouth, right. That's what we both are suffering from, we’re like, Oh, you need to drink water! But sometimes where you forget to intake it as we should... Right. Absolutely... It should be the easiest thing.

0:35:00.6 S1: It should be, but then it's hard because for me, I tell people hydrate, hydrate, hydrate, but then it's like, Okay, who has time to go to the bathroom? Especially when you're recording or you're seeing patients, but later in life, especially perimenopause or menopause, as we start to dry out, our skin starts to dry out, our vagina starts to dry out, that hydration becomes even more key for feeling lubricated everywhere, but then also to help our liver process all the toxins, we need water, it's instrumental to all of our bodily functions.

0:35:33.0 S2: You're a pretty big advocate for talking about perimenopause and menopause, why is it so stigmatized? Why do we have such a hard time talking about it? And why is it like all of a sudden women hit 50 and they're just blown away by what's happening to them?

0:35:50.4 S1: I think there are so many biases that exist in medicine, there's provider bias, doctors who have made it uncomfortable for women to have these discussions we've all had the doctor who's had their hand on the door knob... Right. I hate that women have been dismissed, it's been a taboo topic, like when you talk to my generation... So I'm perimenopausal too, their mothers for the most part didn't talk to them about it. It was kind of hush hush. If you think about it, up until now, nobody was talking about on TV or in the media, there have been blocks to certain types of advertising, we all know that, my own company has been subject to that, and so there's all these layers of not talking about menopause and then as I've gotten out there and trying to partner with people like celebs and people we look up to, they don't wanna talk about it because that's gonna be a problem for their jobs, we know that there are women in their 60s who are beautiful, vibrant, and I want them to declare “I'm menopausal” so that women see that and not an old hunched over woman knitting as what menopause can mean. JLo is probably there are almost there, Halle Berry, same thing, Michelle Obama, in these beautiful, strong women, I want women to think of that as menopause, not the Golden Girls. 

0:37:11.2 S1: I love the Golden Girls, but nobody wants to feel that way when they're 50 or 51. So all of these barriers have been set up, there's all this stigma, shame and taboo, and then I think the biggest thing that is unfortunate that happens is like you said, women get there and they're like, Oh my God, what has happened, because their understanding of menopause... I might have some hot flashes and that's it, when they get into it and recognize that, Oh my God, I have anxiety and depression, I can't sleep, I have no sex drive. My vagina is dry, sex hurts, I'm gaining weight, I am having brain fog, I can't perform in my job, they're so taken aback because they had no idea, because we don't educate patients, we don't talk about it with each other, we don't share our experiences, and that's why I'm a huge proponent of educating women in the third, fourth, fifth decade of life, so that they know their choices, they then will not be afraid to say, Oh my God, listen, I went through it, it's okay. Let me tell you what I did. You know, it's normal. You're not alone.

0:38:12.5 S1: And so normalizing it, eliminating the stigma and taboo talking to a provider or a girlfriend, I think it's finally gonna break this pattern that we've been in. I love this concept that just bringing that representation or starting that conversation can dramatically improve someone's quality of life, 'cause not knowing that there's things you can do about it or that it's something that happens to everybody, it just keeps people from finding ways to have comfortable sex or manage their hot flashes, so I love that you're starting a conversation about that and making it easier for people to see that it’s not to be ashamed of. Well, 900,000 women left the workforce in the UK because of menopausal symptoms, I mean, here we have women in the prime of their lives, probably executive level, seniors who have so much to teach and give at work, and they left because they either were probably hot flashing or having memory problems, we call it mild cognitive decline, because they weren't diagnosed because they didn't know, and to me that's such a travesty to lose these seasoned experts in the workforce because of something that's so treatable, and then I think the other thing that breaks my heart as I've had patients come to me who had the sexual pain or the genitourinary syndrome of menopause who lost her marriages, they come in divorced because didn't know, and their partner thought that it was rejection, when really it was simple anatomy that could have taken a suppository for six weeks and that marriage would have been saved.

0:39:46.0 S1: It just blows my mind. Wow.

0:39:48.6 S2: You're making generational differences with what you're doing, Dr. Javaid from the pregnancy that you told us about this morning to saving marriages, that's having awareness of these symptoms... That's amazing. Hats off to you for being that type of physician that cares about your patients and really about women.

0:40:11.6 S1: Oh, thank you.

0:40:13.3 S2: Yeah, absolutely. This was a fascinating interview. It’s just delightful to get to know you. I'm wondering if you have for us some takeaways as far as books that you like to reference, or if you have a blog that our listeners could follow to keep up with you and really your thought leadership.

0:40:35.7 S1: Yeah, so you can find us on Instagram and Facebook, HerMDHealth, and our website is her MDHealth.com, where we have blogs, we have a podcast called Her Voice. There is a great book called The Menopause Manifesto, which is amazing and full of lots of information, and it's written for patients, it's not written for doctors, and there's another one that I love called The Vagina Bible. And so those are my two books that you need to read, I think they're great, so that you can educate and empower yourself. My other take home points, or if you're gonna go to a provider, always write down what's going on with you and your thoughts that way you're prepared, especially if you're a little uncomfortable, you have that other website I told you about ISSWSH where you can find a provider who specializes in menopause, and if you're going through it yourself, be brave. Share with a girlfriend. Share with someone else you see struggling, maybe you can help them get to the right person, but those are my thoughts and my take-home for patients, educate yourself, empower each other, and just go in prepared.

0:41:44.7 S2: Fantastic, thank you so much for being our guest. This was... We had 40, almost 45 minutes with a thought leader in gynecological and women's health, so thank you, you are truly... We are grateful for a meeting with you, Dr. Javaid and best of luck in 2022.

0:42:05.4 S1: Thank you guys. Thank you for having me, this was great.

0:42:12.0 S2: We hope you enjoyed this episode of The WE podcast as much as us. If you want more wellness goodies, head over to the WellnessEssentialsPodcast.com for show notes, links and resources mentioned in today's podcast. Remember to hit subscribe on your favorite podcast platform to get all the wellness details as soon as they are released. Cheers to living your healthiest and happiest life.