Episode 50

Menopause, Mental Health, and Misconceptions: A Conversation with Dr. Aoife O’Sullivan

Have you ever noticed symptoms like anxiety, memory loss, or fatigue creeping up out of nowhere? With Dr. Aoife O’Sullivan, I’m diving into how perimenopause can take women by surprise and why so many doctors miss the hormonal connection.

Menopause isn’t just a transition—it’s a puzzle that too many clinicians fail to solve. In this episode, Aoife and I go beyond the usual conversations about menopause being dismissed and misunderstood. Together, we uncover the deeper issues behind why symptoms like anxiety, memory loss, and mood shifts are often overlooked—even by experienced doctors.

Aoife opens up about her personal struggles with misdiagnosis, sharing how she questioned her own mental health before discovering the role of hormones in her symptoms. What makes this episode different? We tackle hormonal health, mental health, and the gaps in education that leave both patients and clinicians struggling to connect the dots.

This isn’t just about the challenges—it’s about solutions. Aoife’s experience shows that with better training, advocacy, and small changes in care, we can transform lives. We also discuss the systemic changes needed to ensure midlife women are supported, not sidelined.

If you’ve listened before, this episode will add depth and new insights to the conversation. It’s a call to action for women and clinicians alike: let’s stop dismissing midlife symptoms and start treating them with the attention they deserve.

Highlights:

  • Aoife’s personal struggle with misdiagnosis and suicidal thoughts in midlife.
  • The impact of perimenopause on mental health, memory, and executive function.
  • How the healthcare system fails women by misunderstanding menopause.
  • The importance of hormone therapy trials and finding the right provider.
  • Steps women can take to advocate for themselves and their healthcare needs.

Dr. O'Sullivan’s Bio:

Dr. Aoife O’Sullivan is a board-certified family physician with training in Ireland and the U.S., specializing in women’s midlife care. Her curiosity about the unique health challenges women face during perimenopause and menopause led her to extensive training with experts like Dr. Heather Hirsch and Dr. Louise Newson. A Menopause Society Certified Practitioner, she is passionate about education and regularly lectures to clinicians and the community on menopause care. Currently, she sees patients through The Heather Hirsch Collaborative, providing expert telemedicine care for midlife women.

Connect with Dr. O'Sullivan:

Website

Instagram 

LinkedIn

Get in Touch with Dr. Rahman:

Website

Instagram

Youtube

Transcript
Dr Sameena Rahman (:

Hey y'all, it's me, Dr. Smita Raman, gyno girl. I'm super excited to have my friend and colleague here today. You guys heard on the introduction part of the quote unquote menopause. That way I shouldn't say that because I feel like people have a negative impression of the menopause now. I think we should exclude that. It's mixed, okay. Anyway, back to that. You can delete that, Today I have the amazing Dr. F.A. O'Sullivan.

Aoife O'Sullivan, MD MSCP (:

It's mixed. Yeah.

Dr Sameena Rahman (:

It's Eepa, no, Eepa, sorry. I'm sorry, why'd I say Eepa? Sorry. I get confused. Doctor. And she's here today for an amazing discussion we're gonna have about all the menopause stuff that you guys wanna know. We're gonna actually focus a little bit on mental health today, but you guys heard how amazing she is. in the intro.

Aoife O'Sullivan, MD MSCP (:

If I, yeah.

The spelling.

lot of owls.

Dr Sameena Rahman (:

And, you know, welcome to my podcast, Guidle Girl Presents Sex, Drugs and Hormones.

Aoife O'Sullivan, MD MSCP (:

Thanks very much. love your podcast. So I'm really excited for that. You invited me on today. Thanks a million.

Dr Sameena Rahman (:

Well, you know, I always ask everyone like what kind of brought them into this, you know, either menopause or sex med space, whatever we're talking about. And so like just so our listeners and or viewers hear about it, you know, what brought you into this space?

Aoife O'Sullivan, MD MSCP (:

So I'm a primary care doctor. started med school about 30 years ago, because we start straight from high school in Ireland. And I was just, I think I'd just turned 19. And so I've been doing primary care forever and always felt that I was missing some pieces of the puzzle. You know, there were always some women who would come in with the similar symptoms, similar age group, and I was never truly able to help them.

Dr Sameena Rahman (:

yeah.

Aoife O'Sullivan, MD MSCP (:

get to the bottom of things and would end up sending them to lots of different specialists. And then, I ended up being one of those women. I, you know, was somebody who would see my doctor every few years for a pap smear. And, the next thing I was in her office all the time, tennis elbow, golfer's elbow, didn't play tennis or golf at that time. Plantar fasciitis, painful knee, painful.

Dr Sameena Rahman (:

We all did. Yeah.

Aoife O'Sullivan, MD MSCP (:

shoulder ended up tearing my shoulder and having quite a large surgery on it and being out of, out of condition for a long time and, had big changes in my energy and my mood and my coping abilities. kept feeling so overwhelmed all the time. you know, I moved over to America 20 years ago and I've never been able to donate blood because

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

There's a thing called mad cow disease. and if you lived in the UK during certain years, you potentially were exposed to this and blood products. And so you're not allowed to donate blood. And so for me, at some point I was like, is this the mad cow disease come to get me? Like, because it, destroys your brain and I couldn't remember anything. I.

Dr Sameena Rahman (:

Really? Yeah. Yeah.

I didn't know that.

Aoife O'Sullivan, MD MSCP (:

was saying to my kids, what is that yellow thing in the fruit bowl that you peel and eat? Like, couldn't even remember the word banana. Yeah. I think it was really scary. Exactly. And I feel like when I, you always forget a word, right? You're reaching for a word. It's really common, but there's a sense that you will find it. But I was in a place where I was forgetting a word. And when I went to try and

Dr Sameena Rahman (:

That's how I feel sometimes. Yeah. It's so frustrating actually. On the tip of your tongue. Yeah.

Aoife O'Sullivan, MD MSCP (:

find it, there was nothing. was like just deep space in there, like blackness. There was nothing for, no path for me to follow. It was, it's a very strange and frightening feeling. And I was wondering, was I developing early dementia? My husband is an oncologist. So of course I was thinking, do I have a brain tumor or some type of terminal cancer that just hasn't been diagnosed yet? And went to my doctor.

Dr Sameena Rahman (:

Yeah, I agree.

Dr Sameena Rahman (:

Yeah, yeah, yeah.

Aoife O'Sullivan, MD MSCP (:

And she listened to me and I'm not a crier at all. Was crying in her office saying, I feel so depressed, but yet I know I'm not depressed. Like I treat women with depression every day and I know this isn't it. And she, you know, I left her office with a prescription for an antidepressant. Which I tried because I had nothing else to do. And to be honest, you know, a lot of my patients have told me this too.

Dr Sameena Rahman (:

It's yeah.

Dr Sameena Rahman (:

Yeah, that's what usually happens,

Aoife O'Sullivan, MD MSCP (:

But there were nights where I was having suicidal thoughts just out of the blue, like someone had inserted it into my head, you know, thinking about something completely different. And the next thought was, I think, you know, my family would probably be better off without me. And that was extremely frightening for me. I told my husband I was having those thoughts because I'd never had depression or anxiety or I had never experienced anything like that before. Yeah. And so.

Dr Sameena Rahman (:

you

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

Right.

Anything. Yeah.

Aoife O'Sullivan, MD MSCP (:

I was lying on the couch, no energy, didn't even, even the thought of unpacking the dishwasher just seemed like this insurmountable problem I couldn't address. scrolling on my phone and I would come across these videos from Dr. Louise Newson in the UK, Heather Hirsch over on Dr. Heather Hirsch over on the East coast. And it started to filter through into my brain and I went, my God, this is.

Dr Sameena Rahman (:

Yeah. Yeah.

Dr Sameena Rahman (:

Yeah. Yeah.

Dr Sameena Rahman (:

This is on.

Aoife O'Sullivan, MD MSCP (:

These are all the symptoms that I have. What? I've never heard of this perimenopause. And I've been a primary care doctor for over 20 years. So it was, and you know what? Ever since that, like the veil was pulled back and I cannot unsee what I have seen. mean, everything makes sense once you know this.

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

that.

Dr Sameena Rahman (:

Yeah, I mean it's funny because some people are like, you just assume everything is perimenopause and I'm like, well lot of it is. It's at least contributing. I mean we always say like midlife women are kind of balancing so many things, maybe a job, maybe family, maybe parents, maybe new careers, everything pivoting. And then just throw in little bit of erratic hormones to the mix and see what happens. It's like a cruel joke sometimes.

Aoife O'Sullivan, MD MSCP (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

It really is. And you very rarely meet a woman who says, I diagnosed myself or I was diagnosed, you know, as going through the menopause transition and everything else in my life is perfect. Like usually there's something going on. Things are not great at work. The kids are having issues. There's marital issues. There's been a loss. And so it is so confusing because those symptoms can be from so many things.

Dr Sameena Rahman (:

Mm-hmm. Yeah.

Dr Sameena Rahman (:

It's.

Yeah, and we know that like, you know, people end up with, you know.

worsening symptoms depending on their history and all that stuff too. But it just, think in general, like women, I mean, it was in the study in the menopause journal, like they just don't feel like themselves. And that's probably the most common complaint that I hear. And I'm sure that you hear too, your menopause practice, but it's really, I mean, it's transformative. And I don't think, I'm so glad that we're all talking about it because it's very difficult to manage. We see it in our patients. We're both going through it on top of everything.

So it's like when people say that and you hear them say it, you're like, yeah. And the irritability, you know, or whatever else.

Aoife O'Sullivan, MD MSCP (:

Yeah, I know. joke when I'm given a talk, cause I try to teach doctors locally here. but I joke saying, you know, you'll know your patients in perimenopause, they'll tell you they have, you know, a tweezers in the car, a tweezers in their purse. And you know, they're having homicidal thoughts about their poor partner because they clap, clap too loud or breathe too loud or chew too loudly. That's perimenopause.

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

So true, my god. You feel sad for them sometimes. But they're also like, you know, they're confused too. They don't know like a lot of them and some of them are not very supportive and some of them are very supportive. So I think it just depends on who you're dealing with.

Aoife O'Sullivan, MD MSCP (:

Yeah, I gave a talk here to a group of women, maybe a year or two ago. And ever since a lot of them have said to me, can you do one for our husbands? So I have often thought I should do a talk just for men locally, you know.

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

Yeah, absolutely.

I hear that too and actually whenever I do them as well, it's kind of like, and actually I love it when partners come in. You know, because I do a lot of sexual medicine, I often will get the partners to come in, but I would say the women that are just talking about menopausal stuff without like real concerns about their intimacy or whatever, like a lot of them come in alone. And so I'm always like, it's a real win when a partner will come in with them and they understand. And then they're all, this light bulb goes off in their head too. They're like, I see.

Aoife O'Sullivan, MD MSCP (:

Yeah. It explains so much. And I think, you know, lot of frustrations probably build up on the partner's side and a lot of misunderstandings and maybe resentment. And then when you hear a specialist, you know, someone who's trained in this say, this is a chemical issue. This is not somebody's personality or a big chain. You know, this is something that's fixable and is a chemical issue and we can help.

Dr Sameena Rahman (:

Yeah. Yeah.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

It really takes a lot of that away that yeah.

Dr Sameena Rahman (:

It's like a relief, you know? It's a need. Yeah.

It's always interesting because I think when you're able to give something a name, even if that's always the first thing that I find that like when a patient understands that this is, know, because women are told so many times, everything is in their head, right? So when I have these chronic pain patients or menopausal, perimenopausal patients, or like the big one I see is like when I have these patients have persistent genital arousal disorder, which I talk about a lot in this podcast, when they know there's a name to it, it's like, wow, like they can then

Aoife O'Sullivan, MD MSCP (:

Hmm.

Dr Sameena Rahman (:

and try to heal themselves. But until then, they were always like second guessing. Well, maybe that doctor was right. Maybe this is not for me. I mean.

Aoife O'Sullivan, MD MSCP (:

And you think there's something wrong with you. You should be able to fix this. You know, it must be up here. So it does. takes that. I feel like there's shame involved in all these things too. Shame and guilt and blame. And it takes all that away.

Dr Sameena Rahman (:

Yes. Yes.

Dr Sameena Rahman (:

Yeah, exactly. And I think the shame around, know, it's just a lot of it is how we treat women in midlife too, right? Like how, you know, as women age, they're more discounted or considered more, I what do they call it, the invisible woman syndrome or something like that, where it's just like they're not even as...

considered a prominent part of society anymore, even though they're the building box and the stapling force of most homes.

Aoife O'Sullivan, MD MSCP (:

Yeah, absolutely. I know it is. It's a really difficult time of life for women. And I think up until this point has been so unrecognized and it's such a lonely time because your doctor is not talking to you about it. Your mother, your own mother hasn't told you about it. Your friends don't talk about it. And so you're going through all of this alone. And for some women, it is horrendous.

And the thoughts of going through it alone is just so, so awful and dismal. And that's what women have been doing really up until now. You know.

Dr Sameena Rahman (:

Well, let's focus in on some of what we're talking about when it comes to, like, I think we both have experienced, but when it comes to our patients and they come in, you know, don't you have the patients that come in with a new onset on anxiety, like, can't get on a plane now, or, you know, depression that they've never had, or ADHD. Like, let's talk about how menopause kind of affects your brain from a mental health perspective.

Aoife O'Sullivan, MD MSCP (:

Yeah, and it really does. And women with ADHD or autism seem to be much more affected by these hormonal changes than neurotypical, say, women.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

They're affected earlier and more severely, it seems. So it's really important. And women who have undiagnosed ADHD and have been holding their life together up until this point by everything having its own little home and reminders on their phone and post-it notes, it all falls apart during this time.

Dr Sameena Rahman (:

Yes. Yeah.

Dr Sameena Rahman (:

Yeah. I just had a patient yesterday with this and she was like a really high functioning, you know, corporate, like amazing, like executive. And she said that she had just gotten a diagnosis of ADHD in this transition and, know, seeking hormones for me. But it was so interesting. She was like, you know, the lack of executive functioning and all of this stuff.

Somehow she was able to do it like somehow she was able to get through and got to the like this really high court in our corporate ladder but you know finally when the hormones the disruption of the hormone fluctuation the roller coaster that we all know is perimenopause is really got her that that's what got her the diagnosis in the end, you

Aoife O'Sullivan, MD MSCP (:

Absolutely. Because I think so much of what happens to us physiologically during perimenopause really affects our sleep. And if you take someone who's able to cope with their ADHD and you take away their sleep, that really has such a massive effect. I mean, I know it's more complicated than that. There are other issues as well. And then the effect just in itself of that lack of estrogen in the brain.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

But if you even just look at the sleep portion, you can see why suddenly you're no longer able to multitask and everything is so overwhelming.

Dr Sameena Rahman (:

It's so true.

Dr Sameena Rahman (:

Yeah, I mean, look what poor sleep hygiene is really linked to, or poor sleep in general is linked to when you get less than seven hours, right? What is it? Diabetes, cardiovascular disease, you know, obesity, like everything actually, you know? So it makes sense, but it's just so, and that's when a lot of women stop sleeping normally, is in the perimenopause.

Aoife O'Sullivan, MD MSCP (:

Every chronic disease. Yeah. Yeah.

Aoife O'Sullivan, MD MSCP (:

Yeah, it's the center of everything. I always say to my patients, even if we can get your sleep back, you're going to feel so much better.

Dr Sameena Rahman (:

Yeah, absolutely. And so, so actually, back to your story, when did you get help? Like, how did you get help?

Aoife O'Sullivan, MD MSCP (:

so my primary care doctor, she's wonderful and she's been great, but she didn't, in my case anyway, wasn't able to put the dots together. so I put the dots together and then I went to the North American menopause society, list of clinicians to see if I could find somebody local. and I found a, an OB GYN who was local working at a great clinic and seemed to have like,

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

everything you could wish for in a doctor, NAMM certified and everything. So I made an appointment to see her and that was nine months away. So I got to the point where I thought, you know, it was probably a month or two after that. And I was like, I cannot go on like this. And so I went back to that list and went through it again. And I got in contact with a nurse midwife locally who was able to see me.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

And so she was amazing. and you know, I went into her and she said something that no one had ever said to me before. She said, I know you're used to being in this chair and taking care of everybody, but now it's your turn to let somebody take care of you. And, I just like fell apart, you know, and no one had ever said anything like that to me before. And it was.

Dr Sameena Rahman (:

Yeah.

Yeah.

Aoife O'Sullivan, MD MSCP (:

It was really lovely and it meant so much. And she took amazing care of me and got me feeling back to myself. one of the things that I never was able to get rid of was the stiffness in my hands. Yeah. And so I kept that appointment with the OBGYN thinking maybe because myself and the nurse midwife had talked about it and we, we could see it wasn't really responding. It had responded to the estrogen initially, but then kind of stopped.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

And so I thought, you know what, I'll just keep that appointment with the OB-GYN and maybe I'll go into her and she'll say, I see this all the time. All we need to do is put you on a slightly higher dose or a mess with your progesterone or add testosterone or something. So I went in and she was horrified that I was on hormones. She said, you're still having periods. No woman still having periods should be on hormones. Now, when I look back,

Dr Sameena Rahman (:

my God, isn't that amazing?

Dr Sameena Rahman (:

a misconception.

Aoife O'Sullivan, MD MSCP (:

When I look back, I should have started hormones about eight years before I did. And I probably would have avoided so many injuries, so much of that anxiety that you were talking about. got to the point where I was barely able to drive over bridges. I mean, I put the foot down if I was going over a bridge. Just little things like that.

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

Yeah. That's what happens to me with turbulence now. Like I can't stand turbulence. Even now I'm just like, please god.

Aoife O'Sullivan, MD MSCP (:

Yeah, I know. And it's so weird, right? Especially if you're not, if you're not, if you haven't experienced that throughout your life, it's really strange. So I sat there in her office, my jaw hit the floor. I just couldn't believe the things that she was saying to me. And she said, you know, you're on them, so I'm not going to take you off them, but you shouldn't be on them. And by this stage, I had done a lot of training in

Dr Sameena Rahman (:

Yeah, it's strange.

Aoife O'Sullivan, MD MSCP (:

I mean, I have a bit of a problem, I think if there is a course on menopause, I have to do it.

Dr Sameena Rahman (:

Yeah. You're done. Right. Because you did Luis's and then Heather's right. And now you're

Aoife O'Sullivan, MD MSCP (:

I, yeah, I've done the international menopause and the, you know, just anything I can get my hands on. I just love it so much. And so I was sitting there going, Jesus, if she's saying this to me. And I, at least I know. Yeah. And so there are so many, and I have met so many women who have been to see that same person and got the same answer I did and left without any help.

Dr Sameena Rahman (:

Yeah. Yeah.

Dr Sameena Rahman (:

certified medical officer.

Aoife O'Sullivan, MD MSCP (:

And it's devastating. It's really devastating. mean, even, even the rates in women of suicide, you know, this increase during the menopause transition between the ages of 45 and 55 is a big spike and it's connected, you know? So it's really dangerous to, for doctors not to know this and to be missing patients left, right, and center because

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

keep it chill.

Thank

Aoife O'Sullivan, MD MSCP (:

these women are having much bigger problems behind the scenes that we're missing and not helping them with.

Dr Sameena Rahman (:

Thank

I mean, what is the statistic? think you're like, what, four times more likely to get an SSRI or an anti anxiety pill than, you know, there and when neither of us are saying that it is sort of the magic bullet that's going to get you through, but it definitely helps. then, you know, if I always say like, what, what are your, what's your philosophy around people whose anxiety doesn't get better with, you know, tweaking the hormones? Like I usually give it a few months and then if it's not, then, you know, that might be time. Cause, cause for some people they need the extra help. They need that.

Aoife O'Sullivan, MD MSCP (:

Yes.

Dr Sameena Rahman (:

extra serotonin.

Aoife O'Sullivan, MD MSCP (:

yeah. So often, you know, probably you're the same by this time you and I see a patient, they've probably seen their, their doctor and they're probably already on something like an antidepressant. So I usually say to them, you know, okay, so you've had like X amount of improvement. So we can do a little trial of hormones and you can come back and tell me if you've noticed any benefit because it's so safe. So what's going to happen if I put a woman on three months of estrogen and progesterone?

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

nothing, she's either not going to notice anything or she's going to come back and say, had improvement in X, Y, Z. And that really gives us a lot of clinical information. You know, so I tend to kind of approach it that way. And then antidepressants are fabulous medications, life-saving medications. And sometimes you women need those, you know, so it's really nuanced, right? Like case by case. Yeah. Yeah.

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

And I always find that sometimes you do have to add those antidepressants or SSRIs or cognitive behavioral therapy. We know it's really great as well. But it is usually multifactorial. And I think that we have to be cognizant of the fact that we have to have a toolbox. We have to have a set of tools that we use to help patients navigate this journey. And they have to have input. We know in sexual medicine, we always get concerned about the SSRI effects on your liver.

Aoife O'Sullivan, MD MSCP (:

Yes.

Aoife O'Sullivan, MD MSCP (:

Exactly.

Dr Sameena Rahman (:

or also orgasm. So it's not like, we're jumping out, most of us aren't jumping to do that initially, but you know, we know that sometimes if you have complete anedonia and you don't want to do anything, that includes not wanting to have sex. And so then we add those in and then maybe you have less complete anedonia and it helps. So it's not always having a negative impact.

Aoife O'Sullivan, MD MSCP (:

Yeah.

Dr Sameena Rahman (:

What kind of stuff, like what kind of misconceptions, because you're now doing a lot of community talks with the other doctors, what other kind of misconceptions around some of these things are you seeing?

Aoife O'Sullivan, MD MSCP (:

I'm seeing a lot of, so that's a big one where doctors think that you can't give a woman hormones if she's still having periods, that she has to be a year with no period before you can start on hormones. That's probably the biggest one. The next biggest one is that, you know, it increases your risk of blood clot, heart attack, stroke.

And so, you know, that's a pretty easy one to dismiss because we have some good information on that and some good papers with transdermal estrogen, just for people listening, is very safe for women who are at increased risk of a blood clot or a stroke. Like if you have migraines with aura or you're a smoker or you're obese or overweight, or you have a genetically increased risk of blood clot.

If you give estrogen through the skin, doesn't go through the liver and doesn't increase your underlying blood clot. But so many doctors don't know that information.

Dr Sameena Rahman (:

Yeah, yes, yes. I get text all the time like, why did you start? She has migraines with aura. And I'm like, yeah. So it's a good opportunity to teach people about it too. Because if you're not up to date on this stuff, it's not what you're doing every day. Then of course, you have to have that intellectual curiosity to want to go on and do more with this.

Aoife O'Sullivan, MD MSCP (:

Yeah. And I always approach it from the point that none of us were taught any of this. You know, you might as well go to your doctor and ask them to help you fill out some legal form. Like they don't have any training in that or to do your crown, you know, on your, on your molar. We weren't taught how to do that. So, you know, it's nobody's fault, but I do think at the moment we're in a stage where women know more than their doctors do about this topic. And that is untenable and kind of, you know,

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

We've reached a point now where we cannot go on like that. there has to, something has to happen where doctors are brought up to date on the evidence.

Dr Sameena Rahman (:

And I think we're all trying to do that and I think there are other organizations that are doing that. Master classes are coming up, all the things. I feel like the movement is there, but it's just a matter of people capitalizing on it to some degree. In terms of actually taking the classes or doing the work that it takes. But even at the Menopause conference this year, what was it, the highest number of attendees ever? What was it, 1,500? I can't remember.

Aoife O'Sullivan, MD MSCP (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

It was. Yeah, they sold out. I know, which is really, really encouraging.

Dr Sameena Rahman (:

Sold out.

Yeah, yeah, totally. What other things are you telling other clinicians in the area? Like what other misconceptions are you seeing in terms of?

Aoife O'Sullivan, MD MSCP (:

Of course, the biggest one is the old WHI study coming out and saying that hormones are related. Yeah. Increased the risk of breast cancer. So that's a big one to address. And, you know, there's, there's a couple of good graphs that are in some of the papers explaining what happened with the WHI results. And I always love watching people's faces when I put up those.

diagrams and graphs when doctors see, that's not statistically significant. That's not what I was taught. Like, you know, if doctors know that something's not statistically significant, then we inherently understand that piece of information can go in the trash. Not that it destroys women's healthcare for 20 years. Which is what happened. Yeah, exactly. So that's probably the biggest one, really.

Dr Sameena Rahman (:

Yes. Yeah.

Dr Sameena Rahman (:

Yes, which is what happened.

Dr Sameena Rahman (:

I see that too actually. But I kind of feel like you're right. Like some of the patients come in and they know this already. They're like, well, I tried telling my doctor and it didn't really work. So I think that's where the frustration lies.

Aoife O'Sullivan, MD MSCP (:

I know. I've heard two, then you hear kind of the follow-up stories and you hear the really positive ones where their doctor was open to learning. You know, like I remember I would get a new patient and they would say, I have this pretty rare condition. Here's some papers on it. And I'd be like, thank you so much. You know, I don't have to go off and do all that rummaging. Thank you. And I would take them home and read them. And then I'd be much better informed on that.

Dr Sameena Rahman (:

Yeah. Yeah.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

topic that I had learned nothing about previously, you know. So some doctors are like that and will be like, what? I didn't know any of this. Let me look into it. And then some others just shut you down, which is really hard for women because then you're in a position where what do you do? You have to go find another doctor. And that's really difficult at the moment.

Dr Sameena Rahman (:

And I think it's really hard, especially in the mental health space too, right? Like if you're really worried about, you know, because women often, I mean, obviously there's a component, we know that estrogen receptors are in the brain and they're there and there's more of them in post-menopause than in pre-menopause. So the brain is looking for these estrogen receptors or estrogen molecules. But I think what's hard is that, you know, if you think that this is all just something going on in your head,

but not like related to the actual biology of it, you know, then some people don't make the connection and people, feel like women just suffer a lot longer. What do you do in terms of when someone comes in with so much like distress around their mental health, like when it comes to the ADHD, the anxiety, depression, how do you approach those patients?

Aoife O'Sullivan, MD MSCP (:

So a lot of women I see are on, they're on, know, trazodone for sleep. They're on antidepressants. They're on, you know, a little bit of Ativan when they need it for anxiety. so I usually, I have, I'm lucky, I have like 60 minute appointments with my patients. So we do tend to get pretty deep, which is lovely. And, you know, go through how important estrogen, progesterone, testosterone,

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

is, are in the brain and how they work alongside the neurotransmitters and how it's all interconnected and, you know, explain that hormones might be beneficial for them. You know, and I always talk, I always use the word trial, like to use, try a trial of some hormones and see if that improves things. And, you know, in general, what I see is somebody will start off on their hormones and they'll come back to me and say,

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

I noticed a big difference and I really haven't been using my trazodone at nighttime or I've really cut down on my dose of Lexapro or I don't need that Xanax anymore. So in general, you hear really positive things like that. It's very rare that I don't have a woman come back and say she had good results. Yeah. Yeah.

Dr Sameena Rahman (:

No effect. Yeah, I agree with you. Sometimes what I've seen actually, and this happened recently with a patient who like had finished her, like this was testosterone. She's like, I didn't, you know, I didn't actually think that my libido or my brain function improved until I ran out of it. You know, and then she was like, I should try to, you know, I should go back on this because I noticed like a difference now that I'm not. So sometimes people don't even remember what their baseline was before they start, you know, cause they're just like, no.

Aoife O'Sullivan, MD MSCP (:

yeah.

Aoife O'Sullivan, MD MSCP (:

I, I really find that. And that is why I love menopause questionnaires. The, the green climacteric scale, for your listeners, you know, you can Google it online or Louise Newsome on her balance menopause website has one that you can print off. It's wonderful. And it's got like 23 questions on it you can score them from zero to three.

Dr Sameena Rahman (:

Mm-hmm.

Aoife O'Sullivan, MD MSCP (:

And I was finding that my patients would come back and they'd be like, yeah, I feel a bit better. Yeah, I do. It's definitely working, but it was all very vague. Like I'm having less night sweats. I'm getting more sleep. And I started doing the menopause questionnaire with them then. So I would do it before we started treatment. And then I would do it, ask them to fill it out. And before I followed them up at each follow-up visit, it's astonishing.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

So, you know, you're seeing results drop from like 57 down to 30 something in six weeks, you know, and you can really, it's so objective and it's so lovely to see it because I love again, watching women's faces when they look at the current one and then I pull up the old one and they can truly see the difference. And they always say, my God, I had no idea it was that bad.

Dr Sameena Rahman (:

Yeah, yeah, yeah, that's objective.

Dr Sameena Rahman (:

Yeah, because I don't remember and I think, you know, on some level like

You know, want to go back to the state where, you we can't actually like get you back to 100 % of like a premenopausal state, right? Like it's not going to be back when you're 20s or 30s, but most people don't want to be back when they're 20 or 30 years old, you know, because like, you know, life is a little complicated as you're trying to evolve and try to fit into your own skin. So I find that most of my patients are so happy being in the midlife and, you know, they feel more comfortable in their skin. They just need this aspect, you know,

to like fix it or you know that aspect and then when the combination happens like there's so much better off than they ever were.

Aoife O'Sullivan, MD MSCP (:

Absolutely. And you know, I think the reason, and you used a word earlier, transformational, like I have never in all my years in medicine, used a medicine that is so transformational to people's lives. It's incredible. People will come back and say, I was honestly thinking about divorce. And now I see that is completely off the table. I feel great about my marriage again. My daughter is speaking to me again. I did not leave my job. You know,

Those are transformational things for people's lives. I've never started anyone on, you know, metformin or blood pressure medicine, and then come back and hug me and say, that changed my life. Like it is transformative medicine. It is beautiful to watch. Yeah. It's like, I really look forward to following up my patients to see how they're doing, because I love those stories.

Dr Sameena Rahman (:

Yeah.

Dr Sameena Rahman (:

Yeah, that's true actually. Yeah, that's so true actually.

Dr Sameena Rahman (:

Yeah, yeah, yeah, I agree with you. And I mean, you you always have those patients who kind of like are gliding through midlife without as much distress. And so they're like, is this something I should use or not? And then we, you know, we have conversations around it. But I love that idea that, you know, how transformational it is for so many other people.

I think actually this is a good place for us to like even under discussion since it's already I want to be cognizant of your time but to end on a good note that like you can really transform yourself but give us a bit of advice for those that are listening you know and they're in distress or they can't find the right person or what would you say to them in terms of you know trying to get the help they need.

Aoife O'Sullivan, MD MSCP (:

Yeah. So first of all, educate yourself. So, you know, there are some great clinicians on Instagram to follow. I think, you know, probably if someone is listening to your podcast, they've probably passed that stage. And then I would make an appointment, you know, a single appointment with your doctor, not to talk about anything else, but just to go and talk about this topic.

and feel them out and see how do they feel about hormones and helping you with yours. They may shut you down completely and no doctor should ever do that to you about anything. So if they do, then unfortunately it probably means for at least your menopause care, you might need to look elsewhere. But if they seem open to it at all, then a great paper

to ask them if they'd be interested in reading is one that Dr. James Simon and Barbara Levy brought out this year. Yeah. And I love that it was in the Journal of Obstetrics and Gynecology because that's a really renowned journal. People trust it. And, you know, you're not saying it's in some weird naturopathic journal that nobody heard about. Like this is a big mainstream journal.

Dr Sameena Rahman (:

Yes

I do too. Yeah. Yeah.

Dr Sameena Rahman (:

Right. Right.

Aoife O'Sullivan, MD MSCP (:

And so, you know, hopefully your doctor can access that and read it, but it goes through all the information a doctor needs to know right now to help a patient with their menopause symptoms. So I think that's a good place to start. And then there are those of us that pretty much just do this now. So, you know, we're out there to help as well. And the North American Menopause Society does have a list of clinicians. So does Dr. Mary Claire Haver.

Dr Sameena Rahman (:

Absolutely. That's a really good point.

Dr Sameena Rahman (:

And then of course, yeah, I think a lot of clinicians, I think, doesn't Heather, is on my list or no? Is it just her? Yeah.

Aoife O'Sullivan, MD MSCP (:

she does. Heather Hurt has a list of all the clinicians who have done her course and her course is life-changing. I mean, you know, I studied really hard for that menopause society exam and there's a big thick book and the type of book that I find extremely difficult to get through. Not even one picture, nothing. It's all black and white. My brain just hated it and I trudged my whole way through it.

Dr Sameena Rahman (:

Yes.

Dr Sameena Rahman (:

Yeah.

Aoife O'Sullivan, MD MSCP (:

And, know, the whole exam was about primary care really. And I felt like the answer to everything was use hormones as a last resort. And I was like, damn it. Like that's what everyone else is saying. I don't want my own society to say that. I want my own society to say, these are safe. Use them properly, you know? So, I felt when I did Heather, Dr. Hirsch's course, not only did I get that really deep understanding,

Dr Sameena Rahman (:

Yeah, I agree with you.

Yeah.

Aoife O'Sullivan, MD MSCP (:

of what's going on, but also I could leave that course and really confidently actually use hormones in my practice, you know, cause I think some of the courses teach you the theory, but you leave going, okay, but now how do I actually prescribe it? And yeah, do tweak it and yeah.

Dr Sameena Rahman (:

Yeah.

Yes.

How do I get, yeah, yes. Yeah, I've said a lot, yeah, because sometimes, I mean, when I got, I got certified before Heather had a course, so I wish, probably I would've, I did take her breast cancer one, but for her, and that was good. That was really good, and so I think that I always tell people to head over there and take a listen, because she has one. Mm-hmm, yeah.

Aoife O'Sullivan, MD MSCP (:

That was so good. Yeah.

Aoife O'Sullivan, MD MSCP (:

There's a nice library of courses now.

Dr Sameena Rahman (:

Awesome. Well, thank you so much, hon. I appreciate you coming to my podcast and dispelling myths and talking about mental health issues, which are still so very taboo, despite the fact that they're so common and can really impact your life in such a devastating way for so many people. So I appreciate your honesty about your own and also how you help your own patients. And you guys can read in the show notes how to find Dr. O'Sullivan. She is an amazing source.

We will hopefully have her back in the future to talk more about some of this. But I'm Dr. Smeena Raman, Guide on Girl. Thanks for coming back to my podcast, Guide on Girl Presents Sex, Drugs, and Hormones. Remember, I'm here to educate so you can advocate for yourself. Please join me on my next episode. Thank you so much. Yay.

About the Podcast

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Gyno Girl Presents: Sex, Drugs & Hormones
Your Guide to Self-Advocacy and Empowerment.

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Sameena Rahman