Dr. Becky Lynn: Easing Menopause with GLP-1s and Cannabis—A New Approach

Dr. Sameena Rahman [: 00:00:00

Hey, y'all, it's doctor Samina Rahman. Gyno girl. I'm a board certified gynecologist, a clinical assistant professor of Ob GYN at Northwestern Feinberg School of Medicine, and owner of a private practice for almost a decade that specializes in menopause and sexual medicine. I'm a south asian american muslim woman who is here to empower, educate, and help you advocate for health issues that have been stigmatized, shamed, and perhaps even prevented you from living your best life. I'm better than your best girlfriend and more open than most of your doctors. I'm here to educate so you can advocate. Welcome to Gyno girl presents sex, drugs, and hormones.

Dr. Sameena Rahman [: 00:00:46

Let's go. Hey, y'all, it's me, doctor Smynarmann. Gyno girl. Welcome to Gyno girl presents sex, drugs, and hormones. I am doctor Samina Rahman. I am a board certified ob GYN and sex med specialist and menopause specialist here in downtown Chicago. And I have been really enjoying this podcast. I hope you guys have as well.

Dr. Sameena Rahman [: 00:01:09

And you are. Please give me some star ratings and, you know, like and subscribe to my podcast. I would love that. But today I had a really good conversation. You guys are in for a treat. I spoke to doctor Becky Lynn, and she is a board certified gynecologist, distance in Missouri. And she owns her own private practice, concierge practice, evora health. And she's pretty amazing, honestly.

Dr. Sameena Rahman [: 00:01:34

She and I are very similar in our journey into sex med and menopause and our history of academic medicine. But she talks a lot about all the ways that she helps her patients in her practice when it comes to sex med complaints. She also is obesity certified in obesity medicine. So we talk a lot about the GLP ones. So you guys are going to have fun with this one, so let's get at it. Hey, y'all, it's me, doctor Samina Raman. Gyno girl welcome back to another episode of Gyno Girl Presents, sex, drugs and hormones. I'm doctor Samina Rahman.

Dr. Sameena Rahman [: 00:02:06

I'm here to educate so you could advocate for yourself. I'm super, super excited to have one of my friends and colleagues here today from St. Louis and a good friend of mine from the conferences we attend, the amazing Doctor Becky Lynn. She is amazing clinician, sexmed specialist, and menopause expert who I met through the International Society for the Study of Women's Sexual Health, which you guys know, I talk about ishwish a lot on this podcast. Doctor Becky Kaufman Lin is the CEO and founder of Evora Women's Health. She's a doubly board certified Ob GYN as well as in obesity medicine. She's a trained sexual counselor and a north american menopause certified physician and she's adjunct associate professor at St. Louis University School of Medicine.

Dr. Sameena Rahman [: 00:02:52

She's licensed to practice medicine in Missouri, Illinois and Tennessee. She's a world renowned expert in menopause and sexual health and a frequent invited guest on women's health sexual health panels and appears regularly on numerous podcasts, television shows, radio shows, and in print. Known for her patient partner education on YouTube and her research on the effects of cannabis on the sexual experience, she has been featured in more, in more magazine, Self magazine, and Martha Stewart Living. She's an international fellow for the for Ish Wish, where she has served on the. As an advocacy chairman and a member of the board. She is past president of the St. Louis Gynecologic Society. So I'm super excited to have you here, Becky.

Dr. Sameena Rahman [: 00:03:30

You know, as a background, Becky and I met through Ishwish in the past few years, but we also love traveling and going. And we met and we actually, like, always go to ISSM world conferences together, which is the International Society for Sexual Medicine. And so we're both, we have a lot in common. Both boards, certified gynecologists, sex med and menopause, people from the doing it in the midwest. And we both have this academic affiliation, used to be in academics, but I'm so excited to have you here. Thank you for joining us today.

Dr. Becky Lynn [: 00:04:03

Yeah, thank you so much for having me. This is fantastic.

Dr. Sameena Rahman [: 00:04:06

Yeah. And we both like to wear vibrant colors at conferences.

Dr. Becky Lynn [: 00:04:08

We do. I love your fashion sense.

Dr. Sameena Rahman [: 00:04:12

We're both like, no, I like what you're wearing.

Dr. Becky Lynn [: 00:04:14

A. Yep.

Dr. Sameena Rahman [: 00:04:16

Anyway, so let's talk a little bit about. I love to ask all of my guests, like, especially for those of us, you know, we don't get the training in school. Like, we don't get the training in residency. You know, 6% of people know how, 6% of graduating residents from multiple specialties know how to treat menopause. And probably, you know, sexmed is even, you know, that or less. So tell me, Becky, what brought you into sexual medicine? And, and then we'll talk about, eventually, we'll talk about your cannabis research and what brought you to that?

Dr. Becky Lynn [: 00:04:48

So I did my training at Washu, regular ob gYn, the basics. And I went. After I finished, I went to a community hospital in Jefferson City, Missouri. And all of a sudden, I was seeing patients who were asking me what to do with low libido. And I had had zero, nothing, no training on that. And I was like. Like a deer caught in the headlights. I didn't know what to say.

Dr. Becky Lynn [: 00:05:11

And this was a while ago, so it was before the Internet. And I got in the mail one day a card about a conference about sexual medicine, and I was like, oh, I've got to sign myself up because sex is so important. Like, it kind of pushed under the rug. Oh, we don't talk about it. It's really important to a happy, healthy relationship. And so I went to that conference. It was actually in Chicago. And I learned was an ishwish or John ish wish.

Dr. Becky Lynn [: 00:05:36

No, it was not an iswish thing. And so I brought all that information back with me. I could help my patients with all things sexual. And I did that in a community hospital for, like, six years or so. And then I went to the University of Missouri, Columbia. I went back to academics, and there is where I found Iswish. I took the isswish courses. I did a preceptorship.

Dr. Becky Lynn [: 00:06:00

I did my. No, I did Michael Krichman. Doctor Michael. So I shadowed him for a while in Laguna beach, and I did his course to become a certified sexual counselor.

Dr. Sameena Rahman [: 00:06:14

Yeah.

Dr. Becky Lynn [: 00:06:14

And as you can imagine, there's a lot of crossover between sexual function and menopause.

Dr. Sameena Rahman [: 00:06:20

Sure.

Dr. Becky Lynn [: 00:06:21

Then I found myself treating more and more perimenopausal and menopausal women. And so same thing. You don't really learn that in your residency and training. I found the North American Menopause Society, went to their conferences, became certified in menopause. And then the last thing that I did was the obesity medicine part, because as you can imagine, so many peri and postmenopausal women struggle with weight gain. So that was sort of the last piece that I brought in, took the courses, became board certified, and I practiced obesity medicine as well.

Dr. Sameena Rahman [: 00:06:57

Amazing. Yeah, we talked about that because I'm in the process of doing that right now, but have the same sort of trajectory. And I think actually talking to a patient for the first time, that has a problem and realizing, like, oh, crap, I don't know how to treat this, and, like, you can research the hell out of it. But going to the people and the experts who are actually, like, writing all the guidelines and all the things is where you have to go. And that's what you and I both did. And now, many years in, I think we're both, you know, this is our. This is our happy spot.

Dr. Becky Lynn [: 00:07:28

It's my happy spot. Yes, I'm with you on that one.

Dr. Sameena Rahman [: 00:07:31

Yeah, absolutely. Well, let's talk about. Well, actually, I want to talk to you a little bit about obesity. Drugs, too, something so interesting. But, you know, the last time, I mean, obviously, I heard you speak in Dubai, we both were there for the ISSM, but previous to that, when the ishwish conference was in St. Louis, he presented a lot of awesome research on sex and drugs. My podcast is sex, drugs and hormones. So you check off all the boxes.

Dr. Becky Lynn [: 00:07:55

I know I never set out to be the sex doctor or the drug doctor, but, I mean, I had to explain that to my children. They think, oh, my mom's kind of cool. But, yeah.

Dr. Sameena Rahman [: 00:08:08

Tell us what brought you into cannabis in the research, because there's a lot of data suggesting. I think I read an article sometime last year that I think it was like upwards of 70% of perimenopausal women who were using cannabis were getting relief of perimenopausal symptoms, like 40% returning to cannabis for some of their symptoms. But I can't remember if that's exactly right. But it's growing that, you know, because so many states have it legal now. But tell me what brought you in, because you're doing a lot of research on it and how so?

Dr. Becky Lynn [: 00:08:35

It sort of fell into my lap when I moved to St. Louis, and I was at St. Louis University, I had a very busy sexual medicine practice, and a lot of women would come to me and say, you know, I have low libido. I can't reach orgasm unless I use cannabis. Then it's all fixed. What do you think about this? And so being, you know, the academic physician that I am, I'm like, well, what is the evidence show? So I went to the literature, published medical studies, and there was very limited data, obviously, because cannabis has been illegal until more recently. There just wasn't a lot of good data. So I set out to get some data myself with one of my partners at SLU, and we designed a questionnaire asking women, how was the sexual experience, libido, overall sexual experience, orgasm and lubrication, when they used cannabis.

Dr. Becky Lynn [: 00:09:33

And we overwhelmingly found a positive association. So the majority of women reported overall, the sexual experience was better, more libido, better orgasm. It really, in this sample of patients that we did, didn't affect lubrication. And I think we had over 200 patients. So it was one of the bigger questionnaires out there, and we published that. And, you know, as you can imagine, because it's sex and drugs, it got a lot of press. Everybody wanted to hear about it, and then we went on to publish just a review of the literature. And.

Dr. Becky Lynn [: 00:10:10

Yeah. And since then, now in Missouri, cannabis is legal, both medicinal and recreational. So things have really changed over the past couple years, but it sort of just fell into my lap, and the research fell out of a question that I was like, well, what is the data show? Well, we really don't have a lot of data, and the data is not great because it's just based on recall and it's just a questionnaire. It's not like you can say, I'm going to give you cannabis and give this person a placebo and, you know, see what happens. So. But it's better than no, better than no data.

Dr. Sameena Rahman [: 00:10:40

And I think it's, you know, it's, it's interesting because there's so much, you know, so much, so many different types of plants derived cannabis. You can do, like, with THC, with. Do you want to speak to, like, the endocannabinoid system and why we think that, like, there might be, you know, some changes, because I always talk about the brain as a big sexual organ and how it's, you know, manifesting a desire based on, you know, your neurotransmitters and hormones and all the things, but maybe just explaining, like, because a lot of people don't even know we have our own sort of endocannabinoid system and how that works on our.

Dr. Becky Lynn [: 00:11:12

Yeah, yeah. So there, there is an endocannabinoid system throughout the entire body. So you have receptors for your own natural endocannabinoids, but those are the receptors that cannabis, an external cannabinoid, binds to. They're in your brain. They're all throughout your reproductive tract. They're all throughout your body. And we didn't really know about the system until somebody was trying to, like, a couple years, not a couple years ago, many years ago, where scientists knew the effects of cannabis, but they were working on figuring out what receptors it binds to. And the scientists discovered this whole endocannabinoid system, and it plays a role in so many different bodily functions, and especially in the reproductive tract.

Dr. Becky Lynn [: 00:11:57

So, you know, we think of cannabis affecting your brain, but actually, you know, there's some data to show that it helps with menstrual cramps because the uterus is chock full of endocannabinoid receptors, and that cannabis can help with pain and neuropathic pain. There's actually good data to support that. So it's. It's everywhere. It's ubiquitous.

Dr. Sameena Rahman [: 00:12:19

Yeah, it's ubiquitous. So. And it's. It's. It's interesting because, you know, most people don't even understand that we have this receptivity to it throughout our tissues. And that's why you see so many different, like, arousal gels and all the things that have, like, cannabis or THC or. I think the hard part is the lack of sort of regulation around, like, what's going into what in a dispensary. Right? Like, yeah, we know there's medicinal purposes for cannabis, and there has been for years, and it's just difficult because this is what, this is how I always talk to my patients about, like, compounded hormones.

Dr. Sameena Rahman [: 00:12:55

Like, you know, we. There's no, like, regulation. So it's like when you take a gummy and one tastes like candy and the other one knocks you. Knocks your ass out for the next day, and it's like, there's no regulation in terms of what's going into it. So. So if you prescribe that for any purposes or, you know, I know this was sort of something you started retrospectively looking at the. At it, and people ask you about it. How do you use it in your practice?

Dr. Becky Lynn [: 00:13:18

Yeah, so a couple things about cannabis in general. I mean, there's, like, over a hundred cannabinoids that, you know, can go into different formulations. And in, you know, cannabis is a plant with lots made up of several cannabinoids, flavonoids and terpenoids. And so, you know, when you go to a dispensary, you can pick this strain or that strain or this strain, and they're all a different constellation, you know, of all these different cannabinoids. So I get asked often, well, what strain should I use? And really, there's no data. There's nothing to say, oh, this one is good for sex. That one's not. So I think it's a lot of trial and error.

Dr. Becky Lynn [: 00:13:58

You know, there's some things that people will tell you, like indica versus sativa. You know, indica's, like, in the couch, like, calmer. Sativa is more wake you up kind of thing. But really, there's so much inbreeding that a lot of, you know, strains are a combination of indicators.

Dr. Sameena Rahman [: 00:14:14

How do you even get a pure sample? Right.

Dr. Becky Lynn [: 00:14:16

Yeah. And so there's really, like, not. I don't have any strain that I particularly recommend. I feel like the good news is that because, like, in Missouri, we have dispensaries, at least it's somewhat regulated now. And so you can, you know, you can get a gummy and it'll be like, okay, five milligrams of THC and five milligrams of CBD as opposed to buying something off the street where you have no idea what's in it or if anybody's added anything that be there. So it is a little bit more. But you had asked, like, where I use it in my practice. The other place I use it is chronic pelvic pain.

Dr. Sameena Rahman [: 00:14:55

Sure. For sure.

Dr. Becky Lynn [: 00:14:56

For sure. Because, you know, I know you've seen probably so many women who really struggle with chronic pelvic pain, and sometimes there's not really a great answer for them. And so for many of my patients will do like, so if I'm going to do cannabis, I prefer the gummy route or a tincture route as opposed to vaping or smoking because that's not good for your lungs. But we'll use a combination of THC and CBD to deal with chronic pelvic pain. And it's basically what I do is I might start with a one to one ratio. The THC helps with pain and the CBD negates the high effect. So we'll start with a one to one. If their pain isn't controlled, maybe we're going to go up on the THC and see how that goes.

Dr. Becky Lynn [: 00:15:43

Or if we tried a one to one and they felt too high, then we might go up on the CBD. So I kind of use it that way.

Dr. Sameena Rahman [: 00:15:52

Yeah. And I think that's an issue we all face when we talk about, you know, chronic pain, sexual pain and such, with patients who may start out with one ideology or that might be the center for their pain. And then once it gets centralized and the brain is sort of involved, the peripheral, do you want to speak to that a little bit, like what that means when people have centralized pain? Sure.

Dr. Becky Lynn [: 00:16:11

Yeah. I mean, and pain is so complex. So what central sensitization is, is where your brain has been hearing pain for so long, it almost rewires itself to hear pain louder. And part of how your brain hears pain, there's neurologic signals that go up your spinal cord into your brain, and then your brain sends descending signals down that are inhibitory. So that way you can sort of blunt how bad that pain is. But central sensitization, it's sort of the brain rewiring itself and it hears pain louder. And so sometimes, like, even when whatever noxious stimuli is not there, your brain can be hearing pain. Yeah.

Dr. Becky Lynn [: 00:16:55

Right.

Dr. Sameena Rahman [: 00:16:55

And that's when we, you know, if you're looking for, like, these FDA approved products we try those neuropathic pain medications to see if we can calm that signal down. But I think, to your point, with the endocannabinoid system, that a lot of patients respond really well to cancer.

Dr. Becky Lynn [: 00:17:09

Yeah, yeah. There's good data to support that it helps with neuropathic pain. Right.

Dr. Sameena Rahman [: 00:17:15

In terms of routes, you said you usually prefer either tincture and versus, like, gummies. Can you talk a little bit about the absorption differences?

Dr. Becky Lynn [: 00:17:22

Yeah, yeah. So I try to avoid smoking or vaping because it's just bad for your lungs. So you can either go a gummy route or a tincture, which is a little drop underneath your tongue, and it depends on how quickly you want that effect. So, unfortunately, smoking and vaping is the fastest effect, but it's not good for your lungs. But a tincture is the next fastest effect, where it's just absorbed into the blood vessels under the tongue, so that's faster, as opposed to a gummy, which can take an hour, depending on what you've eaten, maybe even 2 hours before you'll notice an effect. So when it comes to a gummy, I'll always say you have to give it time, because sometimes people take a gummy and they're like, it's not working, so I'm going to take more. And then, you know, an hour hits, and they're just super high and paranoid and end up in the emergency room. And that's not good either.

Dr. Sameena Rahman [: 00:18:17

Absolutely. So you have to be cognizant of the route that you're using and how it quickly gets into your bloodstream versus how it's metabolized. So I think that's really important to hear when it comes to, like, sexual stuff. Like, what do you, what do you feel about some of these inserts, the vaginal inserts, you know, because there's so many out there now, and they're. So where do you use those in your practice?

Dr. Becky Lynn [: 00:18:36

So I really haven't used them a whole bunch. You know, I know that they're out there, but I haven't really used them to enhance, like, the sexual experience. I did use, I did try for a while. See, before I. Before cannabis was legal, recreational in Missouri, I had several patients try, like, topical CBD. I would say it helps 50% of the time, doesn't do anything 50% of the time. How much of that is placebo? How much is legit? Who knows? It makes biologic sense because, like, CBD binds to the trpv one receptors, which, which I believe is the same thing that, like, capsaicin binds to on the vulva. And so biologically it makes sense, but there's not really a whole bunch of data to support it.

Dr. Becky Lynn [: 00:19:28

And what I found is for some women, it would help with vulvar pain, and other women, it just did nothing.

Dr. Sameena Rahman [: 00:19:34

Yeah, that's kind of how I feel, too. And we all have those patients who, you know, you treat the hormones for hormonally mediated vestibulodynia, but they actually have neuropathic or, you know, nerve proliferation. And some of the treatments are a hard sell for patients. I mean, you can treat their pelvic floor. Yeah, talk about capsaicin with them, and they get a little bit like this, and then you talk about, like the end game vestibulectomy, and then they're still a little bit hesitant sometimes.

Dr. Becky Lynn [: 00:19:59

Yeah. I've never, never done capsaicin with any of my patients. Have you? I'm too chicken.

Dr. Sameena Rahman [: 00:20:04

I have. I have actually a handful that it's usually when it's an acquired nerve proliferation, I feel like they do the best. I mean, I think what, congenital? You pretty much have to go to vestibulectomy at some point, but it's just a matter of how you get there. Cause, like, you have to meet the patient where they are and if they're not ready to try. And, you know, the regimen for capsaicin? Capsaicin is the active ingredient for hot peppers. For those of you who, guys don't know what we're talking about, but it is used for, like, nerve related pain. And so. Cause it binds to the same receptors that doctor Lin was talking about.

Dr. Sameena Rahman [: 00:20:36

And so it's supposed to reduce over time. And the way we do it is usually, you know, 20 minutes. You have to get up to using 20 minutes a day on the vestibule that's already in pain, you know, and you have to use it for at least twelve weeks. But the process of getting to 20 minutes is always a challenge for patients. But the ones that I have that have really stuck it out, like they have gotten, you know, some significant improvement. It's just good. They, like, you know, if I, whenever I offer it to patients and they hear about it and they're like, okay, then some, I'll actually try it.

Dr. Becky Lynn [: 00:21:06

Right.

Dr. Sameena Rahman [: 00:21:07

I think it's some of its cultural, like, some of my patients who are like, okay with hot, like, maybe I'll try it, you know, because they're not as afraid of it. But I agree with you. I think those are the patients that I'm like, well, you know, until we figure something out, you could try CBD oil at the vestibule or whatever to see if it helps. And I agree with you. Like, for me, I've seen maybe 50 50. Like, sometimes it helps, sometimes it doesn't. But again, it's kind of more of a band aid. Right.

Dr. Sameena Rahman [: 00:21:30

So.

Dr. Becky Lynn [: 00:21:30

Yep, yep.

Dr. Sameena Rahman [: 00:21:32

Okay, awesome. So I think that's very interesting, and I'm glad that you did the research because like you said, there's not much out there. So I feel like someone had to ask the questions. And now you're Becky Lynn, the cannabis lady.

Dr. Becky Lynn [: 00:21:45

I was so surprised at how much media attention it got. I wasn't really thinking that way or prepared for that, but it was kind of fun. I do a lot of podcasts about it and.

Dr. Sameena Rahman [: 00:21:54

Yeah, okay, the other thing I heard you talk about, what actually in Dubai, you were talking to sort of about breast cancer survivorship, because that's one of your passion points, too.

Dr. Becky Lynn [: 00:22:03

Yes.

Dr. Sameena Rahman [: 00:22:03

And the use of hormones. And I've had many people talk, doctor Coren, men talk about actual systemic hormones after breast cancer. We've talked about vaginal. Tell me your perspective in terms of how you approach sexual wellness with the breast cancer survivors that you deal with.

Dr. Becky Lynn [: 00:22:23

Sure. Yeah. I'm actually a breast cancer survivor myself, so I feel like I have a little bit of a unique perspective.

Dr. Sameena Rahman [: 00:22:32

I don't want to say it until you.

Dr. Becky Lynn [: 00:22:33

Oh, no, that's okay. I'll tell anybody, anybody who asked me, I'm no problem with that. And, you know, as you know, breast cancer survivors, especially when you block all their hormones or take away their hormones, can have a lot of sexual side effects, namely painful sex due to, you know, genital urinary syndrome of menopause, which is basically. Basically vaginal dryness due to lack of hormones, but also low libido. So I am a big proponent of low dose vaginal estrogen, low dose vaginal hormones, including enterosa, for women with breast cancer, because they've never been shown to increase the risk of recurrence. And they do a world of good for the vagina. Right. Like.

Dr. Becky Lynn [: 00:23:14

So for your listeners, pre menopausally, the vaginal tissue is thick and moist. It makes lubrication. It's got collagen and elastin, it stretches. And when you lose those hormones, it gets thin and dry. It doesn't lubricate, it doesn't stretch, and sex becomes painful. And I feel like for breast cancer survivors, you get the diagnosis. It's all about getting rid of the cancer. No one's going to talk to you about your sex life going forward but it's really, really important.

Dr. Becky Lynn [: 00:23:43

And low dose vaginal estrogen is minimally absorbed, and like I mentioned, doesn't really increase the risk of recurrence. So I'm a huge fan of that. When it comes to systemic hormones, I'm. I don't feel comfortable prescribing systemic hormones to someone with estrogen receptor positive breast cancer. Knowing what I know, you know, and I've looked at some of the data, I'm personally still not comfortable.

Dr. Sameena Rahman [: 00:24:12

Yeah.

Dr. Becky Lynn [: 00:24:13

Because I don't know. I feel like we're not there yet. I feel like. So maybe, you know, the pendulum is gonna swing, and I don't know if doctor blooming's new book has come out yet. They said September. I need to get that book. And I'm, like, looking forward to reading it, but I don't think, knowing what I know, that I'm comfortable giving women with estrogen receptor positive breast cancer hormones.

Dr. Sameena Rahman [: 00:24:38

Right.

Dr. Becky Lynn [: 00:24:39

I'm not comfortable taking them myself.

Dr. Sameena Rahman [: 00:24:41

Yeah. So. And resource before, did you have it before menopause or.

Dr. Becky Lynn [: 00:24:46

Yeah, so I was 39. Yeah. So then that I was on tamoxifen for a while, then I had my ovaries removed and so on. Bromine taste inhibitor for a while. That was the worst medicine ever. So I went back to tamoxifen, but I've basically been menopausal since I was 39.

Dr. Sameena Rahman [: 00:25:04

Oh, gotcha. Yeah. So I think that's the question that, you know, a lot of in the book, estrogen matters. He addresses a lot of these issues about, you know, estrogen and the use in breast cancer survivors that he's dealt with as an oncologist. So I hope they'll have him on the podcast at some point.

Dr. Becky Lynn [: 00:25:21

But, yeah, yeah, I'm really interested in what he has to say. And, you know, there's some compelling arguments there. Yes, there are. There. I heard him on a podcast. I can't remember whose podcast it was. I don't know. I'll have to try and remember.

Dr. Becky Lynn [: 00:25:37

And there are some problems with the habits trial, which is the one that said you can never use estrogen in breast cancer survivors because it increased the risk of recurrence. There's some methodological problems with the trial. So who knows? Maybe ten years from now, things will be different. But it remains to be seen.

Dr. Sameena Rahman [: 00:25:58

Yeah. If a patient knows the data and understands the risk, you know, and they're in certain amount of distress or concerned about, you know, cardiovascular, brain, stuff like that, we have a discussion around it, and then I'll, you know, do it based, you know, case by case basis.

Dr. Becky Lynn [: 00:26:16

Right.

Dr. Sameena Rahman [: 00:26:17

Some patients have had, you know, I have. I have a couple patients, you probably have the same. That have had, like, mastectomies. They've had their ovaries out. You know, they've had all the things, and they're like, well, you know, do I even need to see a gynecologist? I'm always like, yes, you still have a vagina of pelvic floor. We got to check everything. But I think that, you know, it's really a case by case basis for most people to evaluate it, and it's.

Dr. Becky Lynn [: 00:26:38

A quality of life issue. Right. Like, if you look at the risks and have all the information and your quality of life is suffering enough, it might be worth it to you to take whatever risk is there. So definitely in case by case.

Dr. Sameena Rahman [: 00:26:54

Yeah. Or if you have, like, really strong cardiovascular risks and you go into menopause so early and you worry about, like, you know, heart disease will probably still kill you before breast cancer will.

Dr. Becky Lynn [: 00:27:04

For a lot of number one killer of women, for sure.

Dr. Sameena Rahman [: 00:27:07

Absolutely. Okay. Well, that's. I'm glad you talked about that, because that was my other aspect that I want to talk to you about. And then I do want to delve a little bit into obesity medicine because we talked about it at issue last time about how I've been using glps in my office, GLP ones in my office for the last couple years, and I started using them with PCOS patients, and I realized that, you know, some of them were struggling on metformin. They couldn't get rid of the visceral fat. But can we talk about a little bit in the midlife woman who was suffering with so many issues around everything? But one of the number one complaints we always hear is, like, I never gained weight in the midsection, and now all of a sudden, I am. So if you can address that, like, why that happens, and then let's talk a little bit about why, you know, and some of these medications are so remarkable.

Dr. Becky Lynn [: 00:27:56

Yeah. So a couple things happen to women in the perimenopause that contribute to weight gain. So one of them is loss of muscle mass. So every year, women will lose a little bit of muscle, and muscle burns more calories than fat at rest. So as you lose a little muscle, lose a little muscle, lose a little muscle. If you eat the same and exercise the same, your metabolic rate will be slower because you're less muscular, you'll gain a little, gain a little, gain a little, gain a little. And you might. And so what I hear in my practice, women are like, I haven't changed anything.

Dr. Becky Lynn [: 00:28:29

I'm eating the same, exercising the same, and now I'm gaining weight.

Dr. Sameena Rahman [: 00:28:33

Right.

Dr. Becky Lynn [: 00:28:33

And the thing with estrogen is estrogen improves how well your insulin works. Estrogen improves insulin sensitivity. So as estrogen levels are declining in the perimenopause and then really low in the post menopause, the chance that a woman is going to be insulin resistance resistant goes up and insulin resistance leads to weight gain. So. And so what insulin resistance is, it's where your insulin's not working well. So your body has to pump out more insulin to get the same amount of glucose from the bloodstream into the cells to use for energy. And high levels of. Insulin is an anabolic hormone.

Dr. Becky Lynn [: 00:29:12

It makes you deposit fat, and it prevents the breakdown of fat for fuel. So the main. The main thing, like, one of the big take home messages about obesity is it's not all calories in, calories out. If only it were that simple. Absolutely not. So, glucose metabolism, insulin plays a role, but as far as, you know, women in midlife, the loss of muscle and the increased chance of insulin resistance that are contributing to weight gain. And estrogen affects body composition. So when there's more estrogen around, you're more likely to deposit fat at your butt and your bust and your hips.

Dr. Becky Lynn [: 00:29:48

And as those estrogen levels decline, it becomes more in the middle, your belly and visceral, which is a risk factor for metabolic disease.

Dr. Sameena Rahman [: 00:29:56

Right, exactly.

Dr. Becky Lynn [: 00:29:57

And so that shows up around the time of menopause, too. Like, women who always had good cholesterol, all of a sudden, they, like, hit 50, and now their cholesterol goes up and. Yeah, yeah, it's very frustrating.

Dr. Sameena Rahman [: 00:30:10

Very frustrating.

Dr. Becky Lynn [: 00:30:11

Yeah.

Dr. Sameena Rahman [: 00:30:11

And I think that it goes to show that, you know, it's really a systemic issue. It's not just like you're losing reproductive capacity. And I think that for a lot of people who are, you know, menopause natural and all these things, of course, but it is something head to toe. We always talk about receptors from head to toe, and it really can impact your overall cardiovascular health, metabolic health, you know, everything.

Dr. Becky Lynn [: 00:30:34

So when you.

Dr. Sameena Rahman [: 00:30:35

When you see these patients, tell me what you do for the workup. And, well, let's talk about GLP ones. For instance. You've been around for a long time, right? People have this misunderstanding that this is just a new trend, but I think it's just gotten a lot of traction because they work so well. And, you know, Hollywood has picked up on this.

Dr. Becky Lynn [: 00:30:51

Yes. Yeah, yeah. And so just to back up a little bit. I do. Like, I'm never. I don't want to, like, I don't think it's right to say, here's your GlP one in a year. Like, losing weight and just, like, maintaining a healthy lifestyle is so important. So in my practice, I have two dieticians that I work with.

Dr. Becky Lynn [: 00:31:11

We talk a lot about healthy eating, avoiding processed foods, limiting added sugar, cutting back on alcohol. That's another thing. Like, the pandemic brought a lot of people into, like, drinking a lot of wine at night. Not good for you, not good for your weight. So we talk a lot about diet, what you're eating. We talk a lot about exercising and strength training, like, building muscle. And then I do use GLP ones. And GLP ones.

Dr. Becky Lynn [: 00:31:40

The way that I look at them, they are a game changer for people who have struggled with. There are people, you know, like, it's in their genes. Everybody in their family has obesity. They exercise, they're trying so hard to eat right. They just can't lose weight. And we really do look at obesity as a chronic disease. So just, like, high blood pressure. If someone has high blood pressure, you put them on a medicine, brings their blood pressure down.

Dr. Becky Lynn [: 00:32:04

You don't take them off the medicine because it'll just go right back up. So, you know, for. For many people, there's a role for GLP ones and lifelong use of GLP ones. And it's not a failure on your part if you need a GLP one.

Dr. Sameena Rahman [: 00:32:20

Because it's fault with GLP ones. You know, it's really. I mean, it's so surprising in the media, people, whatever. There's so much. Yes.

Dr. Becky Lynn [: 00:32:30

Yeah. You should not be shot shaming, right?

Dr. Sameena Rahman [: 00:32:33

Yeah.

Dr. Becky Lynn [: 00:32:34

The way that, like, you. The bigger picture, the way to look at it is like, it's way better to be a healthy weight and be on one medicine and to have obesity and be on a medicine for your diabetes, your high cholesterol, your high blood pressure. Obesity puts you at higher risk for 14 cancers, including breast cancer, including uterine cancer. So if you need to be on one medicine, we should be grateful that we can help people maintain a healthy weight. And another thing that I think is super important, that doesn't get enough traction, in my opinion, is self confidence and how you feel about yourself. Right. So when you have obesity, you don't feel good in your clothes. That leads to depression.

Dr. Becky Lynn [: 00:33:14

Like, how you feel about yourself is so important. And I think it's just as important as avoiding chronic disease due to obesity.

Dr. Sameena Rahman [: 00:33:24

Absolutely. And can you talk a little bit about how these medications work, because, like I said, they've been around, I think for. Was it close to 20? I mean, I think the first oral one was, what, 20 years ago or something like that.

Dr. Becky Lynn [: 00:33:35

I don't know. I know they've been around since for more than ten.

Dr. Sameena Rahman [: 00:33:38

Yeah.

Dr. Becky Lynn [: 00:33:38

But they're not all super new, so they work in three ways. So they go to your brain and they tell your brain you're full. So GLP is a hormone that our bodies make and our intestines. When we eat, food travels to your brain and says, hey, you're full. And that helps you stop eating, but it's got a really short half life. So the GLP one agonists act like GLP, but they stick around for a long time, so they help with satiety. They also slow down how quickly food leaves your stomach so you feel full longer. And then they keep your glucose and insulin levels in check, which is why they're also diabetes drugs.

Dr. Becky Lynn [: 00:34:14

So they work in those three ways.

Dr. Sameena Rahman [: 00:34:17

Right. And I think what's interesting is that, you know, the feeling that you're talking about where you're full sooner, that whole satiety feeling is that food noise that people feel right in their brain. And so that's what I feel like people say the most. It's like, oh, the food noise has really calmed down.

Dr. Becky Lynn [: 00:34:35

Yeah, it's gone. Or like, people will forget to eat or they go out to dinner and they look at a menu and nothing looks good.

Dr. Sameena Rahman [: 00:34:43

Right.

Dr. Becky Lynn [: 00:34:43

So it really does remove, you know, we're so naturally built evolutionarily, it makes sense to want to eat food. And then you give somebody a GLP one and people are like, I can't believe it. I went all day and I just totally forgot to eat. Or the food noise thing where, like, you know, it's always in the back of your mind, what am I going to eat next? Oh, I know there's a cookie in the pantry. Am I hungry? No, I'm not hungry, but I really want that cookie. It just, like, for so many people, wipes that out.

Dr. Sameena Rahman [: 00:35:09

Right. And what's interesting is, and I'm sure you've seen this in your practice, but I think, you know, there's going to probably, I think there's more research being done on this. Is, you know, is it working, you know, on, you know, on your dopaminergic pathways? Because now I have patients who are like, you know, these, like, religious shoppers who have no desire to shop. They come in like, it's like all their, like, you know, habits that, you know, gamblers who stop gambling, like, there's. What is it?

Dr. Becky Lynn [: 00:35:36

Drinkers? Alcohol. It makes people not want to drink. They lose the craving for alcohol.

Dr. Sameena Rahman [: 00:35:42

Right. So I think that's going to be probably the next level of even looking at it. Like, is this something we can use for smoking cessation or other things that might be helpful? But you know what's interesting to me, and this will, you'll find I'm going to be presenting this case at the conference in Rio, or not presenting it, but where it's a poster. But it's interesting to me, too, that these GLP ones, the way they act on your brain, like, when you think about sexual function, what's happening? And so I've had some patients that have some persistent genital arousal disorder. I have this one case of a patient who really, in perimenopause, had increased anxiety. All these things gained weight. Her treatment was very, like, it was a very long process of getting her there, which included CBT therapy, it included sex therapy, included pelvic floor therapy, included hormonal optimization, but eventually, like, what? Shut down her? Like, final PGAT symptoms? We're going on glps. Isn't that crazy?

Dr. Becky Lynn [: 00:36:38

Oh, my gosh. I've. Because I feel like PGAD is the hardest thing to treat.

Dr. Sameena Rahman [: 00:36:43

It's.

Dr. Becky Lynn [: 00:36:44

So patients, we try this, we try that. Nothing works.

Dr. Sameena Rahman [: 00:36:48

Nothing works.

Dr. Becky Lynn [: 00:36:48

So now that I've heard that, I'm gonna put that on my list of things to try.

Dr. Sameena Rahman [: 00:36:54

Right. I mean, because I think I spoke to a couple other sex med docs, too, and they were like, one or two of them had also said they had tried it with patients who have obesity or, you know, some other thing that it actually then turned it off for them, which is interesting how, you know, the dopamine is settling down or, you know, what's happening there, but, you know, it's something potentially worth trying on patients who have other comorbidities.

Dr. Becky Lynn [: 00:37:17

Yeah, yeah. And honestly, like, the way I look at that, like, if you're, like, if you discuss the risks and benefits, like, what is the harm in trying it if there's a chance it's going to help somebody's pee gad.

Dr. Sameena Rahman [: 00:37:30

Right.

Dr. Becky Lynn [: 00:37:31

You have to be careful if someone's really thin, we don't want to take away their desire to eat. Right. But PGAD is so tough. Like, there's just nothing that always works. It's so life altering.

Dr. Sameena Rahman [: 00:37:43

Yeah. But when you have that persistent genital arousal or that genital pelvic, you know, abnormal painst sensation yeah. You know, it's. It's life altering for people, for sure.

Dr. Becky Lynn [: 00:37:51

Yeah, it's horrible.

Dr. Sameena Rahman [: 00:37:53

Yeah. And so, um, that's. You'll see that poster and Rio that we're presenting. But it's. It was very interesting, actually. But I think that, you know, also just looking, does it affect sexual function? I know. I want to say it was like Andrew Goldstein who made a comment at the last ish wish conference about it and whether or not we should look at, you know, how does it affect libido? How does it affect, you know, because if your drive to do other things are going down, is your going down. And I think I could see it both ways.

Dr. Sameena Rahman [: 00:38:21

Right. Because if someone is obese and then all of a sudden doesn't feel good about themselves, what do you think?

Dr. Becky Lynn [: 00:38:26

Yeah, no, I think it could go both ways. Like, maybe it'll lower our craving for sex. But sex is so complex, desire so complex. If you lose weight and you feel better about your body, that's going to improve your libido. So who knows which, you know, which route is going to have the bigger effect, bigger magnitude effect. Who knows?

Dr. Sameena Rahman [: 00:38:44

Right? And I think both of us practice really precision medicine, so we don't cookie cut anything until one patient, another patient. So it's. It's a lot of times it's trial and error. You know, it's like, let's see what works for you. I mean, let's see what, you know, we know that with hormones, sometimes we do that as well. You know, you could do it better with a patch or a gel or oral or, you know, whatever the case may be, but it has to really fit you and your lifestyle and what you can take and sometimes what insurance covers.

Dr. Becky Lynn [: 00:39:10

Yeah, that. Yeah.

Dr. Sameena Rahman [: 00:39:13

How do you like in terms. Because that's another big issue with the GLP ones that we're trying to get FDA approved coverage for these medications and using the ones that, you know, can, can be covered by your insurance. So, you know, I think it's gotten better from what I've seen. What do you tell your patients or listeners? Compounded versus FDA.

Dr. Becky Lynn [: 00:39:38

Yeah, so I don't use compounded. I think I have, like, a few people are doing it at their own risk. Right. Like the FDA has recommended against compounding. So I try my darndest to use regular FDA approved. You know what you're getting. There's a lot of craziness out there on the Internet. I would never just buy my semiglutide from some random Internet site.

Dr. Becky Lynn [: 00:40:01

Yes, that's dangerous. So I like, 99% of the time, just do FDA approved. I personally, so, like, I tend to choose Zep bound before I choose Lego v. There's no head to head trials, but just from experience, I found that people tolerate it, at least in my practicing, that people tolerate Zep bound a little bit better and have more weight loss. But I had plenty of patients on Wagovi, and it works great. And sometimes insurance will cover bogovi and not zep bound, or it'll cover Zep bound and not Govi. Do you know, we'll typically call it in, we'll do the prior authorization.

Dr. Sameena Rahman [: 00:40:38

We'll, every one of them needs a prior authorization.

Dr. Becky Lynn [: 00:40:41

Everyone? Yeah. Never just cover it. Whatever data they need, we'll send them the records, we'll beg them to cover it. And sometimes it gets covered, sometimes it doesn't.

Dr. Sameena Rahman [: 00:40:52

Right.

Dr. Becky Lynn [: 00:40:52

I do have many patients who pay out of pocket, and it's really expensive. It's like 575 for Zepp bound per month. So what we'll do sometimes to defray that cost, and there's no studies to support this, but to save money, we'll try and go every ten days or every 14 days, especially when they hit maintenance. So that's one of the things that I've done to kind of bring the cost down. But this week I've learned that there are now maybe, you know, there's going to be vials of zbound.

Dr. Sameena Rahman [: 00:41:23

Yes.

Dr. Becky Lynn [: 00:41:24

So where like, the 2.5 dose is going to be 300 and something dollars.

Dr. Sameena Rahman [: 00:41:29

Right.

Dr. Becky Lynn [: 00:41:29

Five milligram dose. I can't remember exactly. It's going to be more in the, I think, four or 500 range. But our rep is going to come talk to us about how that's going to work so that, I mean, every dollar that you can save is, is helpful. So I'm kind of excited about these vials as opposed to the pen.

Dr. Sameena Rahman [: 00:41:47

Right. And probably a little more environmentally friendly as well.

Dr. Becky Lynn [: 00:41:50

Yes, a lot more.

Dr. Sameena Rahman [: 00:41:52

I think, and I think that's an important point to make because now, I mean, I feel like when insurances, when they, when they were first getting really popular, you know, it was like thousands of dollars to pay for ozembic or, you know, Wigovi. Now Zep bound has been around for about a year or so. Right? A little over, a little over a year. So I think that it's important to note that, you know, nowadays you can actually, and it's still a lot of money, five to $600. But that's what a lot of these compounded places are charging, too. So, like, if you can get the FDA approved medication, you're, you're not going to, like, be, for the most part, you're not going to be, like, spending a lot more for the FDA approved stuff versus.

Dr. Becky Lynn [: 00:42:31

Yeah.

Dr. Sameena Rahman [: 00:42:31

What I've seen, I've taken some patients off of compounding when they realize that the cost is almost similar.

Dr. Becky Lynn [: 00:42:37

You know, I would never pay that much for compounded. There's, it's not safer, it's not better at all. Right. FDA approved is the way to go because you know what you're getting. It's regulated. You know, it's safe, you know, it's effective, know what's in it.

Dr. Sameena Rahman [: 00:42:52

And I think both of us probably get why it exists the same way we know why hormone compounding exists because there was such a, like, for at least with hormones. Like, nobody was getting hormones. So this industry came out and, you know, has really been thrown. Yeah. And then I think that's why the compounding is existed, too, because, you know, getting the FDA approved products, number one, they weren't able to keep up with supplies. Right.

Dr. Becky Lynn [: 00:43:14

There were shortages.

Dr. Sameena Rahman [: 00:43:15

Yeah, the shortages and then, and then I. The cost and everything like that at some point, but I think that, I think they're finally kind of catching up now. So that's good.

Dr. Becky Lynn [: 00:43:24

Yep. Yeah. Yeah. We haven't had a problem getting different doses like we did for a while. I think in the springtime, it was, it was tough. People would either have to go up or down because they couldn't get the dose that they needed, so. But we haven't had that problem lately.

Dr. Sameena Rahman [: 00:43:40

Okay.

Dr. Becky Lynn [: 00:43:41

Yes.

Dr. Sameena Rahman [: 00:43:41

Yeah. I think it's gotten a lot better. So I think that, you know, trying to find someone from obesity medicine or, you know, is going to be really important for, for getting the right type of overall care because you're right. It's just not give you the shot and go, you have to still increase the amount of protein. Like, what kind of stuff do you tell your patients?

Dr. Becky Lynn [: 00:43:58

Yeah. So protein is super key. So I tell women at a minimum, 100 grams of protein a day. So approximately like 30, 30 grams a meal.

Dr. Sameena Rahman [: 00:44:07

Yep.

Dr. Becky Lynn [: 00:44:08

You need your protein. Otherwise, when you break down fat for fuel, you're going to break down fat, but you're going to break down muscle, and that's going to slow your metabolic rate. So two things to maintain your metabolism, strength training and getting enough protein in your diet. Otherwise, your metabolic rate is going to slow down anyway because of metabolic adaptation, which means your body senses that it's a little bit starving, so it's going to become more efficient. You'll burn fewer calories just living. So that's going to happen anytime you diet. But what you can of what you can change is not you're good. You can prevent losing muscle mass with eating enough protein and strength training.

Dr. Becky Lynn [: 00:44:49

So pretty much 100 grams a day, at least 30 grams in a meal. And protein controls satiety, too. So it really helps you feel full.

Dr. Sameena Rahman [: 00:44:58

Right, exactly.

Dr. Becky Lynn [: 00:44:58

So I'm all about the protein.

Dr. Sameena Rahman [: 00:45:00

Good. And I think that's important, too, because I think that's something that, you know, you hear about a lot of the negative information around some of these drugs is, oh, it's going to cause me to lose my muscle. And they're not muscle wasting drugs.

Dr. Becky Lynn [: 00:45:14

Nope, they're not. You just have to work out. And I feel like sometimes people get these and they're so effective that they don't have to eat right and they don't have to work out.

Dr. Sameena Rahman [: 00:45:24

Yeah.

Dr. Becky Lynn [: 00:45:24

That's when you lose muscle mass and it doesn't look good. It's not good. You need your muscle to keep your bones strong. Muscle is the key to longevity, you know. So use, they can be utilized in an incorrect way.

Dr. Sameena Rahman [: 00:45:38

Right, exactly. That's where they talk about that. Remember that there was a lot on online for a while about ozembic face.

Dr. Becky Lynn [: 00:45:44

Yep.

Dr. Sameena Rahman [: 00:45:45

That's not a thing. It's just you lost weight in the weight.

Dr. Becky Lynn [: 00:45:48

It's not Zembic. Yeah, same with hair loss. So when you restrict calories, it's stressful and stress, you're going to lose hair. So people are like, does zep bound cause hair loss? No, weight loss causes hair loss.

Dr. Sameena Rahman [: 00:46:00

Right, exactly.

Dr. Becky Lynn [: 00:46:01

Yeah, yeah.

Dr. Sameena Rahman [: 00:46:01

I mean, I always talk about. I tell patients, well, at some point you do have to choose between your ass and your face, you know?

Dr. Becky Lynn [: 00:46:07

Yeah, yeah.

Dr. Sameena Rahman [: 00:46:08

When you lose weight in your face, it does. You look a little older, like, it's fine.

Dr. Becky Lynn [: 00:46:13

Yeah. And that's, you know, I don't know if you see this in your practice, but because my practice is mostly, like, for women in their forties and fifties, they'll lose weight in their face. And sometimes women are like, well, I want to be what I was when I was a teenager. And when you're 50, you get so gaunt. It is not the same. So we try. We talk about what is a good, healthy weight and what looks good, but I sometimes feel like losing it too fast. Yeah, yeah.

Dr. Becky Lynn [: 00:46:43

But I feel like sometimes we have to, you know, set good expectations. And I do think, like, trying to be what you were when you were 16 is usually doesn't look good when you're 50.

Dr. Sameena Rahman [: 00:46:53

Exactly.

Dr. Becky Lynn [: 00:46:54

Yeah.

Dr. Sameena Rahman [: 00:46:55

You know, it's the same thing, like, with bounce back culture. It's like you have to start, you know, aging in a way that you feel confident in yourself, but also, you know, you're probably never going to get back to that point, you know, like, which is okay.

Dr. Becky Lynn [: 00:47:08

Like, no need to be back at that point.

Dr. Sameena Rahman [: 00:47:10

Right.

Dr. Becky Lynn [: 00:47:10

It doesn't look good. It's not healthy.

Dr. Sameena Rahman [: 00:47:12

Yeah.

Dr. Becky Lynn [: 00:47:13

So we just need to get that out of our minds. Oh, well, I used to weigh this. You just want to find a way where you feel good, you look good. Just don't compare to what it was like way back when. Find a new happy place.

Dr. Sameena Rahman [: 00:47:25

Right, exactly. And I think that's what you and I both try to do is, like, as both. As ob gyns, we both went through a period where saving lives and delivering babies and, you know, ectopic pregnancies and all that stuff. And so sometimes my colleagues ask me, like, don't you miss, like, being in the. Or saving those lives? And I'm like, well, now all about, like, really improving the quality of someone's life. Right. Like, making them feel a better version of themselves, because I think that it's also a way to save someone's, you know, like, absolutely.

Dr. Becky Lynn [: 00:47:54

I totally agree with that 100%. And that's what I love, what I do.

Dr. Sameena Rahman [: 00:47:58

Exactly.

Dr. Becky Lynn [: 00:47:59

Because I can really help people.

Dr. Sameena Rahman [: 00:48:01

Last question, Becky. What about, like, what advice do you give people? Because obviously, we all know, and we've. We hear, you know, we hear the stories from our patients every day. Like, I saw seven doctors before getting this help. I saw, you know, this and that. I always have to ask, like, what's your advice on how best a patient can advocate for themselves or find the best help they need in sexual medicine concerns or menopause concerns or any of it?

Dr. Becky Lynn [: 00:48:26

Yeah, I think this is a really good question because our healthcare system is a little bit of a mess. So in traditional healthcare, you get about five minutes with your doctor, maybe seven. And that's not enough to go through risk, benefits, side effects of hormones, or to discuss low libido, which is super complex. And so I feel like a lot of women will go to their regular physician who may not have training because it's not part of the standard training or. So they ask a question, they get an answer. Oh, well, you're just getting older, which that just drives me crazy, because that's not the writing, and it'll go away. Yeah, that's, like, the worst answer. Wine is definitely not the answer.

Dr. Becky Lynn [: 00:49:05

And the other thing that I think people don't realize is when you go for your annual, insurance will not let you address a problem as well. So if you're there for your annual and you're like, by the way, I have low libido, your doctor's not going to address it, and then you're going to feel gaslit. Yes, because they didn't address it. It's really, it's not their fault. It's because insurance won't cover it, which is just highly unfortunate. So when it comes to menopause and sexual health, I think finding a practitioner who, you know, has extra training in this is the way to go, who's going to take the time to talk to you about it. So I always refer or talk to my patients about going to, like, menopause.org, which is the Menopause Society website, which is excellent evidence based, good information. And then they have a list of members of the Menopause society and then a list of those that are certified.

Dr. Becky Lynn [: 00:49:55

So they really did the test and the training and the continuing medical education. And same with Iswish. So Iswish has a list of providers go to if you're looking for help with sexual issues, if you go to your regular standard Ob GYN, like, they're just not going to know. And I don't fault the Ob gyns because, like, I don't do robotic hysterectomies. So someone might come to me and be like, tell me about a robotic hysterectomy, because you're a gynecologist. And I'm going to be like, I know nothing. So, you know, medicine is so highly specialized, it's important so you don't feel gaslit. So it doesn't take you seven doctors to go to a place like iswishdev.org or menopause.org.

Dr. Becky Lynn [: 00:50:35

dot.

Dr. Sameena Rahman [: 00:50:36

Absolutely. I always say the system is set up for women to fail. Right. Because the system is an insurance based system where the bulk of the money is based on the numbers that you see and the reimbursement is crap. And so any system that is based on that, really, I mean, you and I both been in academics where we had to see 30 patients a day or. Yeah, just, you know, it's not feasible. And then as a result, yeah. And then the physician gets burned out.

Dr. Sameena Rahman [: 00:51:04

Like, I mean, I know you could, you could probably relate to this. Like, I think back to, like, when I first started and, you know, being in the academic centers and how there might have been that patient as you're leaving the door said, but what about my sexual pain? And you just were like, you know, you don't have time to go.

Dr. Becky Lynn [: 00:51:19

You don't have time to address it.

Dr. Sameena Rahman [: 00:51:21

Like, I feel bad retrospectively thinking about those patients that I couldn't, you know, because the system is rigged against us. The other part of the system is we don't get the training. So that's.

Dr. Becky Lynn [: 00:51:31

Yeah, yeah. I can tell you that the day that I decided that I was leaving academic medicine and I was going to open a concierge practice was a day that I saw a pelvic pain patient and I was so behind. Because you get, oh, double booked, triple booked. Like, I was so behind and I did the best I could in the shortest amount of time, and I walked out of the room and I'm like, that is not fair. I did not do my best by this patient. I felt horrible. So I called her at the end of the day and finished out the visit. But I was like, I have to leave this system because it's important to me to provide the highest quality care.

Dr. Becky Lynn [: 00:52:08

And you can't do that in a five or seven minute visit, right?

Dr. Sameena Rahman [: 00:52:12

I think you and I both go home at night. Like, I was the same way. I would just do that patient the service she needed, you know, and you just. It eats you up, actually.

Dr. Becky Lynn [: 00:52:20

It does. It does. Because we want to help. That's why we're here, right? Yeah.

Dr. Sameena Rahman [: 00:52:27

Well, thank you so much, Doctor Becky Lynn, you're amazing. I love everything that you say and do. So I'm excited and I'm excited to see you. Well, next couple weeks in the menopause conference again in Rio. So we'll have a couple of, you know, coffee sessions and talk a little more. But anyway, thanks for joining me today. My name is Doctor Spinerman. This Gyneco presents sex, drugs, and hormones.

Dr. Sameena Rahman [: 00:52:48

I'm here to educate so you can advocate for yourself. Please join me next week for my next episode. If you have a second, please subscribe to this podcast. I'd love for you to be a.

Dr. Sameena Rahman [: 00:52:57

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Dr. Sameena Rahman [: 00:52:59

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Dr. Sameena Rahman [: 00:53:12

To get more information, my practice website is www.cgccago.com. my website for Gynel Girl is www.gynegirltv.com. my instagram is Gynel Girl, so please follow me for some good content. Additionally, I have a YouTube channel, Gynell.

Dr. Sameena Rahman [: 00:53:32

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Dr. Sameena Rahman [: 00:53:34

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