Doctor Answers Women's Health Questions

I'm Dr. Amy Shah:

MD author, nutrition expert.

I'm here to answer your questions from the internet.

This is Women's Health Support.

[upbeat music]

Triangles13 asks,

Does anybody else feel horrible mentally

the week before their period?

This is such a great question

because this helps me clarify something.

People always think that their period

is the time where they're gonna feel awful,

but, actually, if you know about hormones,

you are gonna feel terrible the week before your period

because your hormone levels,

progesterone and estrogen, drop precipitously.

And when they do, often you'll feel irritable,

you'll have sleep issues, you'll have cravings,

and this is called the late luteal phase.

And so there's a really big misnomer.

And, usually, day one of your period,

you're starting to get your hormones back.

And so by day two and three,

you feel like a million bucks.

In the late luteal phase,

women tend to have the lowest mood of the month.

So this is when you feel the most anxiety.

You can feel depressed.

The rates of suicidal ideation go up during this time.

If it's happening to a point

where it's severe or causing you

to think about harm or harm to others,

you need to get help.

A question from the r/NoStupidQuestions subreddit:

Do we know why heart attack symptoms are wildly different

between men versus women?

So for far too long, women were never studied in medicine.

So something like heart attacks was only studied in men.

And so we only knew about the typical symptoms,

like, oh, crushing chest pain

in the left side or going down the left arm.

And that seemed to only hold true for the majority of men.

And we don't actually understand exactly why they get

such different symptoms.

We think obviously hormones play a role into it

and also how you perceive pain.

And we actually got it so wrong

that women had much worse outcomes

when they do have heart attacks

because a lot of people don't know

how to pick up on these alternative symptoms.

So if you are having nausea,

you're having back pain,

fatigue that just doesn't go away,

these alternative symptoms could signal a heart attack,

so you need to go get it checked out.

PeaceComfortable6583 asks,

Is there negative consequences

for taking birth control long term?

There aren't really that many known side effects

of taking long-term birth control.

People will say

that sometimes it takes a few cycles

when you get off of birth control

to actually be able to get pregnant.

So it takes a little time for your hormones to recalibrate.

There's a little bit

of an increased risk of blood clots, for example,

but other than that,

there doesn't seem to be any real negative consequences

for taking it for many, many years.

That's documented through large medical studies.

So it should be safe and effective,

and you should be able to get off of it

and have normal fertility.

JENNIE TALWARTZ says,

@grok can a woman in perimenopause still get pregnant?

Is it rare?

Are such babies healthy?

People often ask me,

How do you even know if you're in perimenopause?

There's actually not a great test.

It's all based on symptoms.

So yes, cycle changes for sure.

Hot flashes, night sweats,

definitely signal of perimenopause,

but there are things like fatigue, anxiety, which, you know,

obviously can be so many other things.

As we move through perimenopause,

we have less and less eggs in our ovaries

to the point where certain months an egg

might not even get released.

And so you don't even get a period.

That's why people will say their cycles are really irregular

or they'll get no period for one month

or they'll get irregular period

because the egg reserve is very low at this time.

But when I said low, I didn't say no.

That means there are still eggs being released,

and it is definitely still a time that women get pregnant.

And this happens all the time.

Women will think,

Oh, I'm in perimenopause.

Like, I'm fine.

I'm protected.

And nope, they get pregnant.

And can this pregnancy be healthy?

Absolutely, it can be healthy.

There's definitely more precautions you have

to take for pregnancies over the age of 35

and definitely over the age of 40,

but it's definitely possible,

and it happens all the time.

@brainrotpill asks,

Why are people on the timeline pretending

that women's health isn't genuinely under-researched?

That's absolutely right.

We know so little about women's health,

and partially that's because women were not included

in research at all

until the '90s where it was mandated by the NIH

that you have to include women

and minorities in research studies.

So what researchers used to think

is that women are complicated, they have cycles,

and they're also likely to get pregnant.

And so they just left them out of every single study.

And so basically, we have an entire bank of literature

that everything is based on,

all medical care, all medications,

that were never tested on women,

and we have almost no studies

before this time on women's conditions at all.

Any medication or procedure

that pretty much is on the market

was never tested on women,

and the dosing is just a smaller dosing than men.

And so there's this saying is like,

Women are not just small men.

You can't just decrease the dosing.

Like for example, a medication like Ambien, a sleeping pill,

women were having extreme side effects from it,

falling asleep at the wheel,

having dangerous situations in the morning

because women metabolized this medication

very differently than men.

But we didn't know that

until women had started having all these

adverse side effects from it.

In the 2000s, actually, there was another mandate

to do more work on, specifically on women's hormones

and women's issues,

and not just include women

but also spend more time understanding women's health

was put into play.

But even today, there's many, many, many more studies

on male conditions than there are on women conditions,

like endometriosis, for example.

Isabella Maria DeLuca asks,

Thinking about trying the carnivore diet.

As a woman, what are pros and cons?

The pros is that you're probably gonna get

a lot more protein than you did on a typical American diet,

which is great.

Women need protein.

And another pro is that you're probably

not eating a lot of snacks

because you're needing to eat whole foods.

And so it could mean that your diet quality improves.

When you're eating a carnivore diet,

which is like an all meat diet,

you're really not eating a lot of fiber.

And my concern for you as a woman

is that fiber is the backbone to our hormones,

to our brain health, to our immune system.

If you're able to eat a carnivore diet

with adequate amounts of fiber

from fruits and vegetables,

that's another story.

Then, I'm not as concerned.

And if you're asking me what kind

of diet women specifically should be eating,

I would say as you move past 35 and up,

you really need to be following a framework.

This is actually a framework that I've created

that's in my new book, Hormone Havoc: 30, 30, 3.

30 grams of protein in breakfast in your first meal.

30 grams of fiber throughout the day.

And three servings of probiotic food.

This is backed by thousands of medical studies.

It's a framework that can help you thrive through the years

of perimenopause and beyond.

@nootgeiszler asks, Hey, anyone have a way

to plan my work schedule around my menstrual cycle?

How might one bring that up to their boss?

I think the wave of the future is going to be that.

I think if you really wanna support women in the workplace,

you have to take their menstrual cycles in consideration.

It's not a secret.

It's not weird.

It's not, you know, taboo.

It's something that all women experience,

and it's very variable.

So for example,

one woman might experience extreme dysphoria, low mood,

bad mental health symptoms

right before their period in that late luteal phase.

Another one may not feel very different.

So it's not a one size fits all,

but I do think we need

to bring the conversation into the workplace.

For example, for me, personally,

now that I can manage my schedule a little bit better

that week before my period,

I tend to try to make it as light as possible.

I'm not trying to push myself to the limit at that time.

As opposed to the late luteal phase,

the week before your cycle where you want

to maybe keep your schedule a little bit lighter,

have more recovery time

and less big decisions,

the time of your mid cycle,

so between day 12 and 18,

this is an amazing time to push yourself,

to make the big decisions,

do the things that you want to

at your peak brain and body health.

And if that's possible for you in your workplace,

and you'd like to do that,

that's something that I think can really benefit you.

And if that's the case for you,

that is something that you can bring up with your employer.

Obviously, it's not super common in the US today,

but I think it should be.

I think we should definitely keep that into account

because people will be more productive

and happier in their jobs.

@my_guy_Phil asks,

What's the deal with women and migraine headaches?

I need some knowledge

on why so many ladies suffer from migraines.

Women do have much more of a diagnosis

of migraines than men,

and we think this is because of changes in hormones.

So estrogen is very, very tightly linked with migraines.

So is progesterone.

And so our fluctuations in hormones often trigger migraines

or some kind of headaches in women.

Sometimes evening out that hormonal fluctuations

will improve migraines for women.

So taking something like an oral contraceptive

or hormone replacement therapy to normalize

and keep the hormones at more stable levels

rather than a rollercoaster

can help with migraine treatment.

Charterflights57 asks,

Best age to freeze eggs?

20s or early-mid-30?

I think it's a great idea to freeze eggs

in your 20s or 30s.

Once the egg is frozen,

it doesn't really age,

so it you freeze your eggs in your 20s,

you don't use it till your 40s, you're fine.

The only thing I would say is there is a cost

consideration for storing your eggs.

So certain places let you freeze for 15 years

or others let you freeze for 10 years,

and so you'll be having to pay

that many years of egg storage.

And so if that's a concern for you,

that's the only reason I would say you would wait.

But honestly, having a younger egg is much more preferred

when it comes to pregnancy and viability.

@radiantamerican asks,

Endometriosis is one of the top five most painful diseases

in the world.

Endometrial tissue grows all over your body

and organs like cancer.

In many cases it debilitates you more than cancer.

But one of the biggest studies on it

were how attractive women that have it are.

Endometriosis is so common

that they think that 10% of women

of childbearing age worldwide actually have endometriosis.

This is where the tissue

that's like the lining of the uterus

actually occurs in other areas

like the ovary, or the fallopian tubes,

or even outside of the pelvic region.

For example, you're getting PMS.

A lot of people feel pain in their pelvic region,

but when that tissue is outside of the uterus,

it's extremely painful.

And so women will complain of extremely painful periods.

They will have missed cycles

because of this tissue being in other places.

And this person's absolutely right.

It's one of the most painful diseases in the entire world,

yet we don't have a way to cure it.

We have very few treatment options for it,

and it's been very understudied.

A lot of people don't get diagnosed for years and years

until they actually find out inadvertently

from something else that they have endometriosis

and they're like,

Oh, I just thought having painful periods was normal.

A Quora user asks,

How effective is cycle tracking for birth control?

If you are really trying to do effective birth control,

I would not recommend cycle tracking.

It is only 77 to like 85, maybe 90% effective.

Not a great way to prevent pregnancy,

if you're not trying to get pregnant.

Peppermocha asks,

Basic supplements for women?

Health, energy, and general wellness?

There's like a supplement for every single thing

in your body,

but if you look at the research,

there are a few that show up

with a good amount of medical evidence.

So number one is vitamin D.

Women, especially as they move

through perimenopause and menopause,

tend to lose their ability to absorb vitamin D as well

or make vitamin D,

and so often their levels are low.

The nice thing about vitamin D

is that you can get a simple blood test,

and look at your levels,

and you'll be able to know whether you need

to supplement with it or not.

But if you do, there are benefits across the board.

Vitamin D acts as a hormone in our body,

and so not only will you feel more energized,

your immune system will function better,

your hormones will function better,

your brain will function better,

and it's extremely protective for women.

And so that is one thing I definitely recommend.

Second is magnesium.

There's various types of magnesium.

The one I like for women is magnesium glycinate.

It is magnesium bound to glycine,

and that is able to go into your blood brain barrier

and help relaxation, mood, and help you sleep.

In fact, there's a study that shows that women

who tended to eat more magnesium in their diet,

they had a slower brain aging,

and they age little bit better than people

who had the typical amount of magnesium in their diet.

And the third one is Omega-3 fatty acids.

So Omega-3s have been shown to lower inflammation

to help with brain health.

If you're someone who doesn't eat fish,

or you're not getting a ton of Omega-3 in your diet,

then it makes sense to get an Omega-3 supplement.

The one that has DHA is great for your brain.

If you're a vegetarian or vegan,

you can get plant-based Omega-3s

which is algae oil.

Those three are the ones

that have the most research backing behind them.

If you're a woman under 30,

and you're wondering

Is there something specifically for that age group?

I think iron can probably be one of the supplements

that, you know, you may need.

It's extremely common in women under 30

who are menstruating to have iron deficiencies.

And so that is another consideration on top

of the three that I already mentioned.

From the explainlikeimfive subreddit,

Osteoporosis. What is it?

What causes it?

Does neglecting to keep physically active a cause?

Osteoporosis is when your bones

become very low in density.

So they become brittle, easy to break.

Anybody can get osteoporosis.

However, it's much more common in women.

And part of that is because women have this hormonal decline

during the years of perimenopause and menopause,

and the stimulus to build bone becomes much less.

So just simply speaking our bones building,

and they're always breaking down,

building, breaking down, building, breaking down.

For the first 25 years of your life,

you are doing more building than breaking down.

And so you have more bone density,

more bone that's being put down, like train tracks,

and then taking down.

But when you reach perimenopause,

so your hormones are now starting

to decrease in a very erratic fashion,

you tend to break down bone more

than you're putting down bone.

And so you have less bone density as you age.

However, if you're someone who's eating a nutritious diet,

if you're someone who's keeping very active,

that is great ways to keep that bone density really strong

and actually put down more bone.

So you can build bone density by doing heavy weights,

doing jumps, doing things that stimulate that muscle,

that pulls on the bone.

And that stimulus that pulls on the bone

actually stimulates your cells

to put down more bone and make it stronger.

And so it is a condition that is lifelong,

but it is somewhat reversible,

especially when you're in that osteopenia stage

where it's right before osteoporosis.

So if you've missed the boat, and you're in your 40s,

and the peak bone density has passed you,

and now you're wondering,

Should I even bother to exercise,

or jump, or do all these things?

Well, I'm here to tell you

that you can actually build bone at any age.

There's not like expiration date

where after that there's no point in trying.

One thing I did wanna mention is that estrogen

and progesterone replacement can be something

that can be used for women with osteoporosis,

and has really great results.

@JoeLarry1594684 asks,

I know so many women who claim to get UTIs frequently.

I've always wondered why.

Honestly, women get UTIs more frequently

just because of anatomy reasons.

We have bacteria that is more likely

to reach the urethra than men.

When women reach menopause, there's also much higher rate

of UTIs because of that loss of estrogen.

The loss of estrogen

makes you much more likely to get a UTI.

And that's why a lot of practitioners today,

including myself, are recommending that women

that are having UTIs should be using

local estrogen for their symptoms.

This is something that is a great way to prevent UTIs

and has had a lot of new research coming out around it.

Crafty-Mixt236 on the Perimenopause subreddit

asks, Get me off of this emotional rollercoaster.

Here's the thing about perimenopause.

It's the 10 years, seven to 10 years before menopause.

So a lot of women in their late 30s and 40s

will experience changes

in their energy levels and their mood.

And this is because your hormones

are actually on a roller coaster.

So instead of having a normal release every month,

you get erratic release.

Your ovaries are running out of eggs,

and so your brain gets mixed from your ovaries,

and sometimes some months will send out a lot of signal

to make more hormone and sometimes less signal

to make less hormone.

And what that does, it really sets off a lot of symptoms.

Our progesterone is one of our hormones

that goes down first in perimenopause,

and that's the one that keeps us calm and helps us sleep.

And when progesterone goes down, we feel very irritable.

We can feel depressed and can have trouble sleeping.

Estrogen also is erratic

and tends to go down during this time

and is also a mood stabilizer.

And so you're losing some of your help to regulate your mood

and your mental health.

And so this is something that is very, very common

and often underdiagnosed or misdiagnosed during this time.

Depending on where you are on your perimenopausal journey,

you may get prescribed progesterone for help with this.

MerMattie asks, When should we start mammograms?

Mammograms, if you don't have

a severe family history risk of breast cancer,

will typically start around the age of 40.

That is a recommended age,

but if you are someone with a strong family history,

strong genetic history, you'll likely want to start earlier

and with bigger modalities than just a mammogram.

There are people that have strong family histories

of breast cancer or carry a gene like the BRCA gene

that makes them much more likely to get breast cancer.

But it's not just BRCA genes.

There are many, many other genes that are associated

with higher risk of breast cancer.

And so that this is something

you definitely want to get screened,

especially if you have multiple members

of your family that have gotten breast cancer.

Exapmle asks, How long do you need to be off

of antidepressants before getting pregnant?

This actually depends on which antidepressant you're on,

what your risk of getting off of it is,

if there's alternative options.

So it's not like a one size fits all answer.

This is definitely an individual question

that you wanna talk to your doctor about

because there's really no need to get off

of certain antidepressants if you need it.

I think it's a myth that antidepressants,

will stay in your system during the pregnancy.

Different medications have half lives,

but usually they're within a week or so.

SquirrelDisastrous95 asks,

Optimal workout routine for women?

Let me just start with saying any workout,

any movement is great.

There is not any workout that I would say is bad,

but there are things that are optimal for women.

If you are someone in your 40s or 50s or 60s,

then doing weight training is something

that's essential for your bones and muscle.

Keeping that muscle

and bone stimulated is the most effective ways

to stave off some of these diseases

and also makes you stronger, makes you feel good.

And so things like not the pink little weights

that you could do, 30 reps.

You wanna pick heavy weights,

weights that are heavy enough

that you can only do three to five reps.

So something like squats, bicep curls, farmers carries,

which is where you carry some heavy things,

and you walk around with them,

pull-ups or dead hang.

The other things that women should incorporate

all their lives is sprint training,

even if it's just once a week.

We have really good new data

that shows that incorporating some high intensity work

in your exercise routine

is extremely important throughout a woman's life.

And, especially as she gets older,

women tend to not do high intensity work,

and the level of their heart health

and strength of pumping declines.

The study used a protocol called Norwegian four by four.

It's like four minutes of high intensity work with a break,

then you do another four minutes like that.

I would say the mainstay for optimal health,

in addition to those two, is walking.

Walking has been shown in many, many studies

to be the best longevity exercise there is.

Walking actually is for any age.

It's an exercise that you can do well into your older ages.

So doing a combination of the walk,

the weight training, and the sprint training

is kind of the optimal routine.

@Fit_Zama asks, Can anyone with PMDD

please share what has worked for them

in terms of keeping the symptoms at bay?

Yaz contraceptives?

Antidepressants? Anything?

Premenstrual dysphoric disorder is what PMDD stands for,

and it's an extremely frustrating problem.

It is when right before your period,

people feel feelings of depression,

despair, often suicidal ideations

and other things like decreased cognitive function,

extreme anxiety.

This is a real disorder,

and I want to talk about it and mention it here

because often women have this,

but they don't even recognize it until someone says,

Oh, there's a disorder.

And if you're feeling extreme changes in emotions

right before your period,

this is something that you need to get checked out.

So one of the things that doctors often will recommend

to people with PMDD is to regulate their cycles

with oral contraceptives.

So our cycles really go up and down through the weeks,

and especially that one week before your period,

everything kind of drops precipitously,

like a very big kind of rollercoaster drop.

If you are started on oral contraceptives,

this kind of rollercoaster becomes more even,

and there's not as big of a drop right before your period.

And so that can be a really nice effective way

to treat this disorder.

There's also other medications, antidepressants,

and other things that you can do

to help yourself during this time.

One of the biggest things is

to even identify that you have this.

@ms__dale asks,

How did you deal with mommy brain?

I need help.

First of all, yes, there is such thing as mommy brain.

Your hormones are in major flux after giving birth.

And that actually gives your brain kind of like a challenge.

A lot of women will feel brain fog

as their hormones are kind of normalizing

to this new post-pregnancy life.

And so mommy brain can be treated

by really giving your brain some love, more sleep,

more sunlight, more rest,

and, you know, do things

to support your brain, like eat healthy foods

and good sleep overnight.

If you do these things to kind of support your brain

through this process,

you're going to have much less symptoms.

This_is_how42069 asks,

Gestational diabetes:

How common is this?

Can you prevent it?

Gestational diabetes is extremely common.

We think that it's because our pre-pregnancy

kind of lifestyle and diet tends

to be high in ultra processed sugar and carbohydrates.

And then pregnancy actually adds an element

of a load to this.

And we actually get in more insulin resistant

during a pregnancy.

And people who are kind of on the edge

become gestational but diabetic.

And so yes, if you had a very healthy diet pre-pregnancy

and great glucose metabolism,

you're less likely to develop gestational diabetes.

Once you have gestational diabetes,

this is something that will resolve once you have the baby,

but it does raise your risk

of having subsequent diabetes later in life.

And so you'll always be someone who's kind of watching

that blood sugar, especially if you've had it multiple times

during multiple pregnancies.

Both before and after pregnancies,

the things that you can do to help prevent it

is to eat a diet that is low in processed sugars

and ultra processed carbohydrates.

Writeswithink asks,

Is anyone else's postpartum PMS symptoms

and periods more intense than before pregnancy?

This, my friend, is actually very common

because when you are postpartum,

your hormones will take a few months to kind of normalize.

And so there's like this very erratic

hormonal cycles that are happening.

Therefore, your periods can be more intense,

and your symptoms can feel different than before pregnancy.

It will take three to six months

to actually go back to normal cycles.

Peacequietnchips asks,

So menobelly, is this here for the long haul?

It's a real thing.

I mean you can call it what you want,

but during menopause, women tend to add weight,

especially in their midsection.

And this is also, again, because of the loss of estrogen.

Estrogen has a lot to do with our metabolism

and where our fat is distributed.

And during menopause,

I think their average weight gain is up

to 22 pounds over this life change and it's a huge change.

Not only is the menobelly annoying

because women don't like how it looks,

it's actually known

to be also inflammatory to our body,

and it's something that contributes to the risk of obesity,

of diabetes, of heart disease, et cetera.

So it's something that definitely should be addressed.

Some of the same things that you would be doing

to have a healthy body before menopause,

it's the same things that you would be doing,

if you have menobelly.

And then although hormone replacement therapy

is not something that specifically helps with menobelly,

it does add more estrogen to your system,

which will help all of the other systems work better.

And so that can help as well.

Perimenopause subreddit.

Why are some postmenopausal women are so against HRT?

There's some good data that shows

that if you're 10 years post menopause,

so if the average age of menopause is 51,

this is people in their 60s,

that you shouldn't start on hormone replacement therapy.

And this is basically

because the risks

of hormone replacement therapy outweigh the benefit.

In general, we want to start menopause hormone therapy

as close to menopause as possible.

And if you're postmenopausal,

especially if you're postmenopausal 10 years plus,

it's less likely to be a good option for you.

@amaku_pretney asks,

What exactly is the cause of fibroids, please?

What I saw is the size of twins, if I'm being honest.

Jesus!

I think 70 to 80% of women,

as they age, will develop some kind of fibroid.

It's just benign, but abnormal growth of the smooth muscle

and connective tissue where it kind

of builds like a little bit of a round ball in your uterus.

And sometimes they can be very large.

And often when they become large they have to be removed.

But if they're not that large,

they can just live there,

and it doesn't cause any issues at all.

@MrCoryJones asks,

Just looked up 'what happens

to a woman's body during menopause'

on my work computer.

There's like hundreds of symptoms

that happen because of the changes

of hormones during menopause.

And so your body actually becomes almost entirely

different during this time.

People often think of menopause as just hot flashes

and night sweats, and it's just not true.

There are things like carpal tunnel syndrome,

frozen shoulder, chronic fatigue, anxiety, palpitations,

constipation, bloating,

and they're, what I just said,

are often very common symptoms that you may not equate

with menopause but are actually very linked to it.

Princesscorgi2 asks, What's one single change

that you made that changed your health for the better?

So as we get older, our circadian rhythms become weaker.

This means that the input that we need from the sun

and darkness needs to be stronger to get the same effects.

So we need to be getting sunlight,

especially early in the morning

to reset your circadian rhythms.

And I'm telling you, one of the biggest things

that has impacted my life and the life of my patients

and readers and followers is to get more sunlight

during the day and to get more darkness at night.

So if you can get two to 10 minutes

of sunlight in the morning, amazing.

And if you can get a total of one hour of natural light

during the day, that can be the ideal way

to improve your circadian rhythms.

You will feel more energized, you will have better sleep,

and you will have better hormone balance because of it.

If you're one of the many people

who gets up before it gets sunny,

or you live in a place that doesn't get sunny at all,

you can buy a light.

Often people call it a happy light.

It's actually been seen in studies to improve mood.

It has to be 10,000 lux of light,

so putting it in your office

or in your bathroom when you're getting ready

in the morning,

and that can be a great substitute.

That's everything for today.

I hope you learn something.

Thanks for watching Women's Health Support.

[upbeat music]