Midlife & Menopause: Why Your Relationships Feel Like They're Falling Apart | Dr. Kate White

Sameena Rahman (: 00:47

Hey y'all, it's me, Dr. Smeena Rahman, Gyno Girl. Welcome back to another episode of Gyno Girl Presents, Sex, Drugs and Hormones. I'm Dr. Smeena Rahman, your host. Today, as you heard in my intro, I'm super excited to have my friend and mental pal colleague and just like my Southern kindred spirit, Dr. Kate White. And we're gonna talk about so much fun stuff today. So thank you, Kate, for joining me today.

Dr Kate White (: 01:14

It is so much my pleasure to be here with you. We have to support the whole menopause, including ourselves and all the ladies out there trying to give care, but also the people that need to receive the care. So it's good to get some words out.

Sameena Rahman (: 01:31

Yeah, absolutely. And I think we always like to refer to you as the bless your heart menopause. We're from the South, so we know what that means.

Dr Kate White (: 01:38

I got excited.

Absolutely. We're like, yes, bless your heart for everything that we're out there doing and everything that's not being done. Right.

Sameena Rahman (: 01:50

For all those that are not doing what they're supposed to, bless your heart. Bless your

Dr Kate White (: 01:54

Yeah. Bless your heart. Bless your heart because you haven't really been given the guidance or taught even how to do it. And that certainly included me. I remember when we all like coming out of residency and I came out in 2002, which makes me 55 next month. And you come out and what's that? June 8th.

Sameena Rahman (: 02:01

Yeah.

Sameena Rahman (: 02:17

What day is your birthday? What day is your birthday? OK. OK. I'm June 24. OK. I'm June 24, so mine's coming up too. I'm a cancer.

Dr Kate White (: 02:23

Come on down, it's a Sunday. We'll go out.

So what we're saying that in: 2002

Sameena Rahman (: 02:35

How you doing?

Dr Kate White (: 02:59

and you will not believe this, it causes breast cancer and everybody needs to stop prescribing this stuff right now. And I hadn't even gotten that much training in it, but I got some training and I came back and was the resident reporter and said, gosh, you will not believe this, but now we are not.

Sameena Rahman (: 03:05

Yeah.

Dr Kate White (: 03:21

We shouldn't be giving all the stuff that we've been giving to women. We gotta stop it because it's gonna give them breast cancer. increases the risk of cardiovascular disease and heart attacks. again, everyone had about a 5,000 foot view of this study without actually being able to dig into the meat of it. And next thing you know.

Sameena Rahman (: 03:40

Yeah.

Dr Kate White (: 03:48

Kari, Katie, Kirk, and all these guys are like, hey, to take your mom off this, go tell her, stop the hormone therapy, it's gonna kill you. And so, and then that was the last time, I was the last generation, I was the last generation of actually that had almost any care, education in gynecologic menopause care. And then after that, I was like, well, I guess I don't need to know how to do that because we,

Sameena Rahman (: 03:51

Yeah.

Sameena Rahman (: 03:55

Yeah.

Sameena Rahman (: 03:59

You're the reporter! You're the reporter!

Dr Kate White (: 04:17

And I went out as a 30 something year old and with no personal experience with menopause and the menopausal changes. again, lot of the people that we did see in clinic, were, I say, you we've heard this before from Mary Claire, but that we were told that, oh.

I'm going to take this person who gets to go, that needs to go the OR for and have her uterus out. You get to take the whiny woman who just doesn't feel like herself and see if you can fix that. And, and so that was where the kind of how I went into practice, not having much education and certainly nothing further available once I did get into being a practitioner and,

Sameena Rahman (: 04:56

I know. So true.

Sameena Rahman (: 05:08

Yeah.

Dr Kate White (: 05:11

and then, so every time that someone came in saying, these hot flashes of night sweats, I was like, well, you can try this, but it might give you breast cancer. It might give you, you know, might have cardiocities. So we'll, if we need it, we're going to put you on it for just the tiniest bit for the shortest amount of time. And then you just tough it out and just tough it out. And I had no idea how, how horrible and how, how

Sameena Rahman (: 05:28

Yeah.

Yeah.

Dr Kate White (: 05:41

how much damage I was actually doing to these women. And it's, it's, it's, it makes me feel very guilty, especially once I became one of them. How that, that you get those feelings in your head. And I think you've probably have seen like the anxiety, the changes in not right. And you're in the middle of all these other changes of midlife.

Sameena Rahman (: 05:48

Yeah.

Yeah, exactly.

Sameena Rahman (: 05:59

I'm gonna run right now. Like I'm running the middle of it right now.

Dr Kate White (: 06:08

And if we can want to talk about what is midlife, midlife that it's that time that we, we start seeing it. Those, those changes, I think in our mid thirties for a lot of us, and some of, some of our patients are in full blown menopause by their mid forties. And they're in these changes where they've got so much relational change to everything in their life. And then they, throw in the hormone changes that they were completely not prepared for by anyone.

Sameena Rahman (: 06:31

Yeah.

Sameena Rahman (: 06:38

Yeah. It's real shit show. always say it's not.

Dr Kate White (: 06:39

And it's a disaster. I think that we both experienced and anyone who's had any kind of hormonal changes is like, remember thinking these words that are coming out of my mouth right now, I know are harmful. Even if they're my true feelings, I know they're harmful to my relationship.

Sameena Rahman (: 07:04

Yeah.

Dr Kate White (: 07:07

And I know they're harmful to the situation, but I do not know. I cannot not say them. It's like, it's a very interesting, like, do you feel like, and when people say brain fog of like, maybe not remembering things, there's also a brain fog of feeling like you're in this cloud of not being able to control what you say. Have you ever, do you have any?

Sameena Rahman (: 07:14

Yeah, no, that's true.

Sameena Rahman (: 07:31

you say. Yeah, it's true. I think it's so interesting because you feel like, you know, I'm someone that's always been a people pleaser. So like, sometimes I'll say it and I'll be like, Oh, crap. Yeah. What did I just say? Yeah. You know,

Dr Kate White (: 07:44

Yeah, absolutely, absolutely. And then you're walking it back and then you add on top of all everything else you have as a people pleaser as you and I, think in most people who go into medicine, a lot of people do, you add guilt to that and you feel guilt, you feel that and these women that are in our same situation, they feel the guilt to their partner or to...

Sameena Rahman (: 07:51

You know what? don't I just...

Sameena Rahman (: 07:58

Yeah.

Sameena Rahman (: 08:02

So the equation.

Sameena Rahman (: 08:11

Yeah. Love you too, Sarah.

Dr Kate White (: 08:11

their family who typically a lot of times takes the brunt of it, but it also can blow up their work relationships and really cause a lot of problems. And that's one of the things that I think that we were talking about is why do we start seeing these increased rates of divorce in this point? And that was one of the things we wanted to talk about today, I think,

Sameena Rahman (: 08:29

Yeah, absolutely.

Yeah, because you have a unique perspective too with your husband, we'll talk about. just backtrack for a second. When I was her intern, we've reviewed that article because it come out think the year before. And we had journal club. And I had this one attending who was amazing at understanding the statistics and absolute risk. And so when we reviewed the study, she was like, it's kind of not as big a deal as they're making it. And we're like, yeah, it's kind of not. But then we still went ahead and took everyone off the abstract.

Dr Kate White (: 08:37

Mm-hmm.

Dr Kate White (: 08:44

Mm-hmm.

Dr Kate White (: 08:57

Yeah.

Sameena Rahman (: 09:04

You know, it's like, oh, it's kind of, it's just an absolute versus relative risk. And they're really blowing this out of proportion and white, but you know, we'll still have to take everyone on a trip.

You know, it's like really bad. then of course, you we, both went and, you know, learned menopause medicine through different people in different ways and different societies and with sexual medicine or issuance and all the things. you know, if you think about it, even a lot of what we know when people say that, you know, is it real gaslighting if doctors didn't know it. And when it comes to like, I said this before in my podcast, when it comes to sexual pain and stuff, like some of that stuff we've only started understanding in the last 14 years. And, know, I graduated, I see what.

Dr Kate White (: 09:22

Mm-hmm.

Dr Kate White (: 09:42

Yeah.

Sameena Rahman (: 09:44

like almost 20 years ago. So of course we didn't learn it then. If you don't continue continuing education, which a lot of doctors don't have the capacity for, right? They're seeing 40 patients a day. They don't get CME. They can't go to all the conferences. You know, they're already behind on their charting. So in some ways, because the system is broken, you know, it's like it doesn't allow for help for the clinic, for the doctor or the patient. I think that's a big problem.

Dr Kate White (: 10:03

Mm-hmm.

Dr Kate White (: 10:09

Yeah. And you're under a lot of pressure and I do say bless their heart, their heart for all the doctors. And I do mean that because they're under a lot of pressure to see people rapidly and get through it. And so if they are not, if they don't have the training then, and it will only make their visits and their interaction with patients more complicated.

A lot of times they'll say, it's a don't ask, don't tell. If they're not gonna pursue, are you having problems with pain? Are you feeling your increased anxiety in your life, in your relationship? Are you having so much sleep disruption that you are not able to function? They won't say, oh.

you know, that might be me, that might be me that needs to help you with that. They'll be like, are you talking to your primary care doctor about that, all these things. So they may hear some, maybe you some Loneasta. And if they haven't had much of the education, then they feel insecure about even offering a solution because they're not able to fully support. I felt that way. was like, gosh, I don't.

Sameena Rahman (: 11:13

Yes.

Dr Kate White (: 11:30

I hope they don't bring it. And this was, and that's why I went and got separate education. But like you said, not everyone has the capacity to leave their practice, go out, get the education. And it wasn't just one visit to Iswich. It was that year and then the next year and then the next year before I felt comfortable. And so it's a long process.

Sameena Rahman (: 11:46

Yeah, three or four.

Sameena Rahman (: 11:51

Absolutely.

Dr Kate White (: 11:55

But that being said, I don't want to belabor that point too much and say what have we learned and what do we know about what's going on out there?

Sameena Rahman (: 12:05

I just, and the one more thing to your point was, I Mary Claire had posted just yesterday or did, that we're blaming everything on perimenopause and menopause, and we're gonna talk about relationships and are they, is perimenopause and menopause to blame?

And I just posted something saying that we're not, it's not a blame, it's naming it. We're actually naming it as a possible issue contributing to everything. And when you name something, there's power in that, right? We know that when your hormones are fluctuating up and down and these hormones modulate your mood, they modulate your function, your cognitive function, they modulate, you know, your weight gain, your weight loss, your sleep, all the things, of course it's going to impact your relationship. If you have anxiety, stress, you're anxious, you're bitchy because you're irritable, you know,

Dr Kate White (: 12:36

Thank you.

Sameena Rahman (: 12:48

Like that impacts your relationship. So a hundred percent these hormones are involved and it's not blaming them It's just naming them as a contributor, right? So I feel like that's that's something that should be emphasized too It's like no no one's just saying everything is about perimenopause, but it is it is part of the equation

Dr Kate White (: 13:05

It is part of the equation. And I think it's, it's an interesting because it comes at a time when you said you've got this evolution. So when we were talking about my husband, this podcast that we're starting called heads and tails. Um, so my husband is the marriage and family counselor. do, um, menopausal medicine and, um, gynecology and sexual medicine. And so we say that so much of the changes that we see in midlife, they are, um, hormone and physiologic.

but they're also psychological. some of it has to do with our own maturity, where we are in our own just general maturity and maturity in terms of our knowing ourselves, but also how long you've been in a relationship, how long you've been in your medical practice, if you're a doctor or your job, and how long you've been a parent.

Sameena Rahman (: 14:02

Yeah.

Dr Kate White (: 14:02

So you've got maturity, but then you throw in this like, I am finally knowing myself. And then like, a minute, my brain is now scrambled.

Sameena Rahman (: 14:10

Yeah. I was like, yeah. Right. Or like the sexual stuff, like you finally figure out what's good for you and then, wait, like I can't get turned on anymore because I don't have testosterone.

Dr Kate White (: 14:22

Right, exactly. Where'd my orgasm go? I hear people say, happened? I was able to, yes, I used to be able to have an orgasm fairly easily. And now my ADD that has kicked in since perimenopause has made it impossible for me to focus on the event of sexual, because we know you got to turn this frontal cortex off.

Sameena Rahman (: 14:26

Yeah.

Sameena Rahman (: 14:42

Yeah.

Sameena Rahman (: 14:51

Yes, you're gonna quit checking off the list in your grade.

Dr Kate White (: 14:52

in order for you to... Right, right. look at those, there's functional MRI is very interesting when you look at this, that one of the things I like about the sexual medicine courses, you get to see these amazing people with these amazing research. And when you, it so resonated for me when I said, saw that, okay, this part of your brain has to be dark in order for your...

orgasm to actually be able to happen. So, so in ADD, when you're in this part goes is shooting off, shooting off thought after thought after thought, there's no way you're going to get there. And so you have to, for people who get so much increase, there's like a 30 to 40 % increase in ADD symptoms. I think that I certainly saw it happen in my itself in menopause and perimenopause.

Sameena Rahman (: 15:25

Yes.

Sameena Rahman (: 15:35

Absolutely.

Dr Kate White (: 15:52

It's a different part of sexual dysfunction. So perimenopause, yes, it's not responsible for anything, it's everything. you do have, it impacts so many areas. If you can't focus, your life is going to be blown up in a lot of different ways.

Sameena Rahman (: 16:05

All right, all right. Exactly.

Sameena Rahman (: 16:12

I mean, we could set the stage, right? Like you, your husband probably sees clients like this. You see patients like this, right? You see a woman in her midlife. She's maybe at the pinnacle of her career doing the best that she can, either as a, you know, whatever. We see it all the time as people are enjoying in boardrooms trying to do something and all of a sudden can't remember. So you got that going on. They have aging parents. So they're kind of managing that, or maybe some parents that have passed away and managing that grief around it. And then you have kids that are maybe growing up or maybe they're already grown, right? Like, so you have that.

Dr Kate White (: 16:18

Mm-hmm.

Sameena Rahman (: 16:42

juggled and then maybe on top of that you have a 20 year old relationship with your significant other that's up and down right we had dr. Laurie mince talk to us about sort of the heteronormative gender roles and how you know some of these actually impact your libido significantly right because if you're the one always doing the cleaning up after every meal and doing the daily household chores or you're the one that's going out there and taking care of your husband while he's sick then you don't feel like having sex with him

Dr Kate White (: 17:12

Yes. Yeah. I think that that was such a strong point in Laurie's lecture that she gave at the Menopause Society about the more you are a caregiver, the less you are a lover. And I think that is a tremendous. And when we say, when we look at statistics in the 60 to 70 % of divorce in the mid in midlife from ages 40 to 60 are initiated by women.

Sameena Rahman (: 17:24

Yes.

Sameena Rahman (: 17:34

happens.

Dr Kate White (: 17:40

And a lot of times we think of it, my husband left me for his assistant or whatever. That is actually, yeah, it definitely happens. But actually it's women more often leaving. And why is that? And again, if you're a college educated woman, it's even higher. But I think a lot of it is that long-term quiet disconnection.

once they find that they feel like they've become invisible in their role. some of it is those gender roles where you're like more and more the person who is putting out the fires and making sure everybody has lunch and making sure everybody has what they need and not really addressing, I don't wanna spend my life in this role. Or they...

Sameena Rahman (: 18:34

Yeah.

Dr Kate White (: 18:36

feel the abandonment of that role once their kids are gone. And now they're like, well, this is who I was. I was the caregiver. was helping everyone do everything. And now, now I'm adrift in that way where I don't, nobody is needing my care. And I don't even know who, I have to recalibrate in my head who I am and what my relationship is to this person who has been my.

Sameena Rahman (: 18:43

Yeah.

we're often to the equation.

Dr Kate White (: 19:03

you know co-parent but not necessarily my lover as much as the co-parent

Sameena Rahman (: 19:07

And I think that's why we see so many women shifting in midlife, right? Like they're trying to find new careers or new relationships to your point, right? Like, and how many patients do we have that are like 67 years old? come, hey, fix my vagina, because I have a younger.

Dr Kate White (: 19:26

Right, things are starting over again for me because I, yeah, it's a, how do you, how do you, so most, a lot of people though say, okay, well, I don't necessarily want to blow up my relationship. I'm not happy with how it is now, but how do I, how do I readjust, recalibrate?

Sameena Rahman (: 19:29

you.

Sameena Rahman (: 19:46

Bye.

Dr Kate White (: 19:53

How do I get to not this? And some of it is addressing some of the physiologic changes, because some of it is hormone changes, or some of it is ADD. So can you either work through that with someone who can help with trying to ride this

Sameena Rahman (: 19:56

Yeah. Yeah.

Dr Kate White (: 20:21

I think we talked about it a little bit with one of our friends, Jackie Piazza said that she relates it. You've been going along and there are these waves that go like this and you're like on your, you're kind of able to body surf them. And then you start getting a tsunami and you're trying to put a surfboard on top of the tsunami and try to ride it out with a little bit more support.

Sameena Rahman (: 20:36

Yeah.

Yes.

Sameena Rahman (: 20:42

Yeah.

Sameena Rahman (: 20:46

Yes.

Dr Kate White (: 20:47

which is like adding menopausal hormone therapy on top of perimenopause. And then you could, or you could just like say, I'm leaving this, I'm gonna go onto the shore and that's more like going on a birth control pill to say, I'm gonna shut this down pretty more so. I mean, like, I will watch this from over here. And will not necessarily be, and none of it, there's no.

Sameena Rahman (: 21:08

Bye, guys.

Dr Kate White (: 21:13

If you decide that you're gonna continue to try to body surf these waves, then you're gonna really have to use other tools that are gonna be like cognitive behavioral therapy, maybe some ADD medicine. You can medicate it from different directions if you don't want to do any hormone or can't use hormone therapy. And you can use therapy like cognitive behavioral therapy to help with some of these things.

Sameena Rahman (: 21:17

Yeah.

Sameena Rahman (: 21:40

Yep. Yep.

Dr Kate White (: 21:43

But you, yes, you can optimize, get the, as I said, I'm a big fan of those bamboo sheets. They're great for the, but you can't, what you can't do is think that you're not gonna do anything about it and you're going to get, you're going to be able to ignore it and redirect and it won't necessarily, if you leave that relationship because of,

Sameena Rahman (: 21:44

try to correct your sleep, try to reduce stress, like all the things you've

Sameena Rahman (: 21:52

No.

Sameena Rahman (: 22:05

It's going to go.

Dr Kate White (: 22:13

what's going on with you physiologically, you're not going to do better in another relationship. So either you decide to become unpartnered because that's the healthiest thing for you and you still address some of those problems. And if you were in a relationship that is, if you're in a relationship that's not healthy for you, if you're in a job that's not healthy for you, then uncoupling from those things may be the best thing, but you're still going to have to address.

the fundamental problems that you're having and whether that's figuring out how to reconnect in terms of intimacy in a different way. make sexual activity be global sexual activity in terms of intimacy and reconnection and talking to your partner about what your new needs are like, hey, I need a vibrator now.

because the changes in my, the tissue of my, that clitoral reactivity is not the same. And it's not you, it's not because I don't love you and I'm not attracted to you. It's just because physiologically I've lost some of the myelin to the receptors of my clitoris. And so, and then when women understand, hey, it's not unusual, you're not broken. These things happen, they are physiological changes. And that,

Sameena Rahman (: 23:27

Yes.

Dr Kate White (: 23:40

Sometimes they can, it feels a little bit more like they can talk to their partner without it being so threatening in terms of intimacy.

Sameena Rahman (: 23:49

Right, exactly. And I think it's important to really look at all those parameters, right? We have to look at sexual parameters. You want to think about just your quality of life and who you're growing old with, right? The one thing I've noticed, you know, we both have lost our mothers and we know what happens when you're, you can see what happens with the other person when...

Dr Kate White (: 24:05

Mm-hmm.

Sameena Rahman (: 24:13

the kids are grown up when the grandkids are growing up when you're no longer working and then you lose the person that you've been with for 50 years. And so if that is that commitment that you're going to continue to make and you're going to grow old with that person, you want to do it in the best capacity that you can, thinking of all the factors that can improve longevity and your overall health. So you have to look at all those health factors too. But I think it's really important. That's something that's really been

Dr Kate White (: 24:15

Mm-hmm.

Dr Kate White (: 24:40

Mm-hmm.

Sameena Rahman (: 24:43

epiphany for me, seeing my dad struggle with my mom's loss, you know, is that like, wow, it's really like if you're going to stay partnered, it's really important to know who your partner is and, and how you can how you can function with or without them. Because, you know, that's I think that's really, you know, telling for so many people.

Dr Kate White (: 24:48

Mm-hmm.

Dr Kate White (: 25:03

Yeah, absolutely. You have to continue to be able to know who you are and how you are. And I think that's somewhat some of what people say at this point in life is saying, I want to I need to know who I am separate from this relationship. I need to be valued separate from this relationship. But I don't necessarily want to detach from it. But

Sameena Rahman (: 25:28

Meow.

Dr Kate White (: 25:32

Unless they're not everyone, not every partnership is willing to ride out that wave of this person needing to know, find those answers for themselves. can, it's, and when we, and try to evolve together, which I think when the other, the other time we see that we, relationships fall apart is if people that in their twenties, you know, they partner and non-partner very quickly.

Sameena Rahman (: 25:45

Yeah.

Dr Kate White (: 26:02

because they're evolving so quickly, that they either evolve together or they evolve apart. And more commonly, they're gonna evolve apart. And so when we look at trying to check in with people and say, all these changes that you're experiencing, all that you're feeling, they are normal. But if you don't address them together,

Sameena Rahman (: 26:02

Right.

Sameena Rahman (: 26:06

Yeah, they're changing.

Sameena Rahman (: 26:15

Right.

Dr Kate White (: 26:30

you're going to be addressing them apart. And then sometimes I think when I hear from my husband as a therapist, and maybe why women initiate divorce more commonly is that he'll say, these women are feeling these things and he said, he'll have a guy come in to the therapist office finally, and he will say, my wife just left me.

Sameena Rahman (: 26:36

Mm-hmm.

Dr Kate White (: 27:00

And he's like, okay, well, let's see what's going, been going on. He said, let me just guess a year ago, she said, we've got some serious problems. And they could have, she could have said it at a loud volume, but she was like, and they started really arguing and they, and, um, and she said, we've got to see somebody. This is not right. I can't continue this way. And then he's like, oh yeah. Well, and the, you just continue to fight. And then about six months ago.

She said, I can't handle this anymore. I'm done with this. We need to see a therapist. And you said, yeah, yeah, yeah, yeah. And then yet two days ago, she said, I told you I was done. Now I'm done. And she's out the door. so, and now you come and say, I think we need to address this. And unfortunately, psychologically, she's done. She's moved on and the opportunity to.

Sameena Rahman (: 27:49

Yeah. She's already gone.

Dr Kate White (: 27:59

address those things is not irrevocably gone, but if you can try to get that communication and I know that sometimes that it's, of course it takes both partners, but maybe if we can put out there that this is a normal thing and these are the changes I'm experiencing, they're normal changes for right now, but we have to address them to evolve together.

just like we did in the beginning of our relationship, maybe we can save some relationships and maybe some relationships can just be uncoupled in the best way that they can.

Sameena Rahman (: 28:42

And I think that's one of the points that I think both of us want to make is, you know, people have to try to understand who they are, where they are at, and what their goals are, and understand, you know, also like their commitment to that person and what it's what it looks like after kids and after parents are gone and after all the things.

Dr Kate White (: 29:03

Yeah. Yeah.

Sameena Rahman (: 29:04

And then if that's something you still want to commit to, then you have to kind of be all in, but also take care of yourself. Right. I think that's something that we all know that women don't do well. We don't take care of ourselves. We don't push toward and we're seeing it now more. think I think more and more women are like, I had to make this appointment. It was something I had to do for myself because I can't continue to live like this.

Dr Kate White (: 29:26

Yeah, so if you can say, recognize those things when they're starting and try to address them sooner, try to say, hey, this is how I'm feeling. If it is something where you're not sleeping and you're having, and it's making a difference in how you're feeling or how your health is.

you're not getting to exercise because you're so exhausted. You're not getting to be able to do the things that you used to, whether it was working out in the garden or whether it was journaling or you're not doing any of those things that help to recalibrate your own brain, then you need to see someone who can help you to get these huge hormonal swings under control.

and be able to help you with sleep disruption. Even the sleep apnea increases by 30 % in menopause and perimenopause. All of these things need to be addressed so that you can even have the capacity to talk to your partner and address things without that rage that can sometimes overtake you. And it's not...

Ignore how you're feeling and ignore your trajectory. And if you need to change course, it's not hormones are not there to, to make it so that you have no desire to change things that need to be changed, but they can potentially help with the brain. being so engaged in fight or flight all the time, because the, that you have that dysregulation in the, in.

Sameena Rahman (: 31:03

Right.

Dr Kate White (: 31:17

the amygdala and the hippocampus by the, because of your hormone changes that you able, you're able to re gain control of the decisions and say, okay, I, I need, I, I can look at this without flying off the handle. and again, a lot of people do get start on SSRIs at this point for that reason, because they say, yeah, I just need to be able to take that step back.

Sameena Rahman (: 31:23

function.

Sameena Rahman (: 31:41

And that's what you do if you're a normal person.

Dr Kate White (: 31:47

and not feel that rage and fly out the handle. And SSRIs can definitely be very helpful to people, but sometimes maybe it could be managed by managing how your brain is being affected by those hormone swings as well.

Sameena Rahman (: 32:07

Absolutely. mean, we do know like 25 % of midlife women are on SSRIs or antidepressants and some of it is necessary beyond hormones. we are like, I know you practice the same way. We try to get hormones a chance first, especially if they're interested in it and they have the other symptoms that may solve it. And if not, if months go by and it's still there, the anxiety is still there and all the things, then there's definitely a role for that and it should be no shame involved in using them.

Dr Kate White (: 32:33

Right. Absolutely.

Sameena Rahman (: 32:34

Yeah, So what kind of advice do you have to give to the women, to people listening? You know, some men listen to this. I've got emails from them that, you know, this has been helpful for my professional and personal life. So what kind of advice do you have for them? We're struggling in relationships. We're struggling with perimenopause. They don't know what to do. They don't know where to go. Maybe they're in a desert where there's not that many, you menopausal clinicians like

Dr Kate White (: 32:45

Yeah.

Dr Kate White (: 32:49

Mm-hmm.

Sameena Rahman (: 33:04

Like what do you tell them? Because we have so many, I mean, you're part of one of the apps too, right?

Dr Kate White (: 33:09

Yes, I work for Alloy on top of my regular job at night. come home and do Alloy, is a online telehealth menopause medicine company that only employs menopause educated doctors, which to really help people manage it. So get some access to, I live in South Carolina and we have 14 counties that have no gynecologic.

access to care and the primary care doctors do not have the time to manage all of that. They bless their hearts again because they, cannot even imagine all the things that they're trying to manage on top of it. Some of them do a good job with it, but it's not really a possibility to manage that much. there are telehealth companies that can help to manage some of those things. If you're not able to access menopause care near you,

Ideally, you'd be able to have that full body. Ideally, it would be the full body menopause care. if you can try to get a little bit of that, that is one way to access it. was with telehealth. And there are a lot of telehealth counseling access, much more than there used to be. Again, that's...

Sameena Rahman (: 34:28

Yeah.

Dr Kate White (: 34:34

makes it so that I hope that that gets preserved and are so much as driven by insurance companies and what they will or will not and by the government what they are gonna will and will not support and hopefully they will continue to support it. But the main thing is to, if you are feeling some of these things and in a time when you're not feeling rage,

Sameena Rahman (: 35:01

Yeah, that's a thing.

Dr Kate White (: 35:02

Find that time to be able to reconnect with your partner or reconnect with the people at your work. Take the time to maybe write it out. okay, I think there's, my husband says, you're never more than three sentences away from healing a relationship. And so just, if you can say, look at to the things that are happening in your relationship and say, and

Yeah, I, if you're saying I need the time to, if it's like your job, for example, we were talking a little bit about that, say, I need the time to work with my patients. I need your support so that I can have 40 minutes with my patients instead of.

15 or seven, which is they sometimes give me, as I can't give the care that I need to give in the amount of time that you're giving me. I need to have some sort of support to try to give the best care I can. Or if it's just, but it's to really start to think about where am I feeling rage? Or where am I feeling

Sameena Rahman (: 35:59

you

Dr Kate White (: 36:27

despair and if you can if you need a counselor to help you do that find the counselor to help you do that if you're saying I am feeling exhausted all the time and that's keeping me from then and say okay, I need to address sleep I need to address what can I get what what needs to change to? Find those pain points in your life whether it is feeling exhausted decreased libido

Sameena Rahman (: 36:27

in community are spending now.

Dr Kate White (: 36:56

you know, that sexual dysfunction or just loss of connection with your partner and say, okay, where can I, how can I address this in, write out a few sentences to say, this is, this is, this is where I need your help. Whether it's your partner, whether it's recalibrating your relationship to your, your work or, or to your parents and saying, I want to help you dad with what you need.

But I need you to give me the ability to help you by instead of calling me while I'm seeing patients at work, in the middle of the day, you would say, I would say, just send me a text or call me at work after work and I will be happy to help you with whatever it is that you need. But you're really kind of recalibrating, readdressing what

Sameena Rahman (: 37:37

Yeah.

Sameena Rahman (: 37:50

Cool. Yeah.

Dr Kate White (: 37:56

the, what you need from that relationship. And if it, if it has to do with you, you really saying I, it's sleep. If it's medicine, it find the, it's a matter of finding a doctor who is going to listen. Cause most of the time, if you listen to a patient, you're going to tell you what it is that they need. And they may not even know how to ask it, but you can, they can, they can tell you and you could say, I think that this can

Sameena Rahman (: 38:15

You'll find it.

Dr Kate White (: 38:25

and finding a menopause, it's not a menopause, someone who has contemporary menopause education is what I try to tell. And you can do that through ISWITCH, International Society for Studying Women's Sexual Health website, the Menopause Society, ACOG, even if you kind of look on the ACOG education, it's not, there's nothing perfect in any of those, but.

Sameena Rahman (: 38:32

Soon.

Yeah, exactly. That's true.

Dr Kate White (: 38:55

Try to find someone who's going to listen to you and has an interest in helping.

Sameena Rahman (: 39:03

Right. And at the end of the day, like my tagline, always say, I'm here to educate so you can advocate. So you have to always advocate for yourself.

Dr Kate White (: 39:11

Absolutely. Find those pain points. And so if I'm feeling rage, why is it? Is it that I'm just not being heard? Is it that I'm feeling abandoned by my kids? Or am I feeling overburdened by my kids? So how do I shift my burden to there? How do I...

find reconnection to my kids. If I feel like I'm being abandoned, if I'm feeling abandoned by my partner, how do I reconnect to that then and let them know that this is a normal stage of life, but it is also one that you can't navigate on your own. You've got to, you can, you can try to recalibrate all you want, but if, and a lot of people that is what they do it. That's why the relationship, you can decide to withdraw from the relationship, but

Sameena Rahman (: 40:02

And usually, they're small.

Dr Kate White (: 40:09

Most of the time you have a lot of investment in all these relationships and trying to recalibrate them rather than eliminate them will be best for everybody.

Sameena Rahman (: 40:23

Absolutely, I believe that too. Well, thank you, Kate. I'm glad we were able to touch on this topic because we don't get to talk about sort of the nuances of relationships and how we both see it impacting our patients and friends and family and all the things. So I appreciate you coming on and talking to everyone about it. And so I'll put in the show notes where you can find Dr. Kate White. Again, she's in South Carolina and she will she's you're launching the podcast, right?

Dr Kate White (: 40:27

You're welcome.

Dr Kate White (: 40:37

Mm-hmm.

Dr Kate White (: 40:52

Yes, it'll be launching hopefully the end of June.

Sameena Rahman (: 40:55

Oh wow, can't wait to hear that. So it'll be fun. It'll be like Kelly and Ripa and what's his name? Mark? Yeah, I hear about this. I just hear about this. I'm like what? I just know Regis and Kelly from back in the day. Now they're really, now Kelly and the guy, her husband, they're doing it. That's what I said. Mark, yeah.

Dr Kate White (: 41:02

yeah, yeah. I know. I should watch. We don't have a chance to watch morning TV. That's right. Regis and Kelly, exactly. We're gonna just date ourselves.

Dr Kate White (: 41:21

Mark maybe something like that. all right. You always give such great, great information. And again, I appreciate all it being here.

Sameena Rahman (: 41:25

Anyway, all right, thank you, Patrick. I appreciate you coming.

Sameena Rahman (: 41:37

Yeah, we'll have to, maybe the next time we'll have you and your husband on. Thanks everyone for joining Gyno Girl Presents Sex, Drugs and Hormones. Remember, I'm here to educate so you can advocate. Please join me on my next episode. Yay! Thanks so much, Kate. All right, I appreciate you.

Dr Kate White (: 41:41

That'd be great. That'd be great. All right.