Navigating the Menopause Maze: Self-Advocacy and Finding the Right Support

Dr. Sameena Rahman [: 00:00:01

Hey, y'all, it's Dr. Samina Ramon Gynogirl. I'm a board certified gynecologist, a clinical assistant professor of OBGYN 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 Gynogirl. Present.

Dr. Sameena Rahman [: 00:00:44

Sex, drugs, and hormones. Let's go.

Dr. Sameena Rahman [: 00:00:49

Today I have a special guest for you guys, and I'm so excited about it. It's a patient of mine that's navigating menopause, and that's what we're going to discuss. And really, I wanted her to discuss her journey as she found me, but really about how she is such a proponent of advocating for your health in menopause and perimenopause and the journey. And so I wanted to bring her on because of a unique journey that she's had. But also, everyone out there can hear a story of how you can self advocate for yourself and actually get to the other side and hopefully find someone that can help you if that's what you're looking for. This episode today is near and dear to me because it is a personal patient of mine who has agreed to speak, know her journey, and she is just a tremendous advocate for women and for menopause. And I can't wait for you guys to hear it. So it's with Heather Zimmerman today and let's get at it.

Dr. Sameena Rahman [: 00:01:48

Hi, everyone. Welcome back to Gynogirl presents sex, drugs and hormones. I'm so excited to have one of my own patients here today who has agreed to talk about her journey. One of the things that we're going to do on this podcast, I'm going to have people that have actually been through some of the issues that we want to discuss talk about their stories because I think these stories are so important for other patients, other people to hear, other providers to listen to so that they can understand what people are experiencing on the other side and how they actually came to get the help that they needed in some of these complex cases that we'll be talking about. And obviously, I'm going to continue to hopefully have some experts on the show to talk about in detail treatment plans and issues. But these stories are very critical, I think, for people to learn from. And so I'm very excited to have Heather Zimmerman on the show. And we're going to talk about how you came to me, but when you realized you needed to get extra care, how you did it, how you started advocating for yourself, because you're an amazing patient advocate and you've really figured out the healthcare system which behooves most people, even physicians, to kind of navigate.

Dr. Sameena Rahman [: 00:02:55

One of the questions that I started asking, the first podcast that I recorded was people have always asked me in my past because of my history and my culture and everything, like, am I brave or am I shameless? I'm going to ask you that too at some point during this conversation, but go ahead, Heather.

Patient [: 00:03:12

I'm Heather Zimmerman. I met Dr. Raman after a very long journey, which I can get into, but we started seeing each other, I believe, at the beginning of February of just this year. And I'm 51, I'll be 52 next March. I definitely noticed some changes in my mid 30s regarding, well, migraines and a lot of joint pain and some things that were very difficult to deal with on a daily basis. And I was constantly going to my practitioner, my general practitioner. I was also seeing a functional medicine doctor. And everybody just either in my general practitioner just wanted to give me medication, gabapentin, or they were giving me paxol back in the day.

Patient [: 00:04:07

But nobody was really interested in getting to the deep cause or the root cause of what was going on. I will say it was a little better once I again, through lots of searching, which this was pre, not a lot of information online and definitely pre Instagram or TikTok or anything like that, I started researching and I did find functional medicine and I was going that route for quite some time. And through functional medicine they did at one very small window of time, have a hormone doctor. She specialized in hormones, and she was the very first person when I was 35 years old, that determined that I needed progesterone and that I was very low on progesterone. And she was basically focusing on just trying to help my migraines, my joint pain. And I was on that for quite some time. She moved out of the country and I felt pretty lost. She had herself, she had no recommendations on who to hand me over to because again, 15 plus years ago, there just weren't people really focusing on the hormone side.

Patient [: 00:05:22

And then I stayed on the progesterone that she had me on, which was a very high dose all by myself. I just kept getting it prescribed and no one could help me, my regular practitioner, my general primary care doctor, nor my functional medicine doctor. She said she didn't really know much. I went to my gynecologist, who I adored, but she said, heather, I don't know anything about hormones. I'm a gynecologist. I know about babies, and I know about women's parts, but not really hormones. So I gave into that and I struggled with that for almost ten years. And then really, the perimenopause symptoms were definitely kicking in.

Dr. Sameena Rahman [: 00:06:11

This speaks to the fact that a lot of clinicians don't get the education they need on menopause, and that's one emphasis I want to make. In a recent study that came out, 30% of OBGYN residencies have anything educational for menopause, and of those 90 something percent are lectures. So some people graduate residency for OBGYN, which is supposed to be a fully women's health specialty, without any knowledge or have never seen a woman in menopause, which is staggering if you think about it. I mean, thinking about all the women in menopause, and that will continue to be in menopause. And so this is one of the reasons that patients like yourself, it behooves them to find someone that can help them, because a lot of clinicians don't know, because they weren't taught, and they don't have the impetus to learn on their own for one reason or another, job reasons. Or maybe their practice doesn't allow them to spend half an hour with the patient or an hour with the patient. So I think that speaks to that big issue of why navigating menopause is so difficult. One part of it, at least tell us about some of the perimenopausal symptoms that develop.

Patient [: 00:07:19

100%. I agree with everything you're saying, and that's why, again, in my mid to late forty s, I had just put it to the back. I just told myself, this is what it is. But once in a blue moon, if I felt I was maybe in a situation that somebody might know something, I would always ask questions like, hey, do you know a doctor? Or do you know, have you dealt with this? And I really was hitting brick walls. People were like, I don't know. I was the one asking the questions, but I was younger than most people, that I didn't have the answers. They didn't have the answers.

Dr. Sameena Rahman [: 00:08:00

Did you talk to any family members, any female family members?

Patient [: 00:08:04

That was one of the problems is we are the next representation. My generation at 50 years old, 51. That we are the ones who are really making this come out of the dark, and we are talking about it with zero shame. And there isn't shame. This is just part of life, and there should be no shame in this whatsoever. Yes, I did go to my mom and I asked her, what is going on? Like, I was having the hot flashes. I was struggling to sleep. The joint pain, I can't see.

Patient [: 00:08:37

For me, it's a little difficult. I have an IUD which was given to me at 35 by another gynecologist who said, that's going to help your migraine. And it didn't, but I did really like the IUD. So that was quite a struggle. So when I would find a doctor who would want to work with me, they were like, well, you're on an IUD. And it's really hard to tell because we can't tell when your periods are intermittent or stopping. And so they kind of just didn't want to deal with me because I wasn't like the cookie cutter patient. And I even googled Chicago menopause doctor, and I found a different functional medicine doctor who specifically listed that he was a menopause doctor.

Patient [: 00:09:22

And I went to see him at 49, and I told him everything I was going through. It's not that I get these hot flashes where I burst into it, but I get hot. And then it takes me a while to cool down. And he just sat back and he goes, well, that's menopause for you. He goes, enjoy the ride. And I was like, wait, you're listed as a menopause doctor. When I googled, that was really upsetting to me, and I kind of jumped ahead. But my mother I did go to, because I remember her having the same symptoms that I was having.

Patient [: 00:10:02

Well, that's the sad part, is my mom was of that generation in the early 2000s, what was it, 2002, when the articles came out? And I remember her being on HRT and she was doing really well. And then she stopped cold turkey. And to this day, it is me fighting to educate her to not be worried about me being on HRT, even though I'm extremely successful here on what you have helped me with, which we can get into. But it is a mindset in the women who currently, now, I believe, are in their 70s plus that should be helping guide their daughters or nieces or grandchildren or whoever they are that are dealing with this. And they have such a fear of HRT that it's a hindrance, because she almost was telling me, stop looking just deal with it. Deal with it. I got through it. You'll get through it.

Patient [: 00:11:10

But because of my determination and my advocacy and my own health, for many reasons, I kept pushing. And so I will say that generation, for me, like I said, we are the ones that need to help others. And if it wasn't for me being on Instagram and it wasn't searching on the Internet, I'm not a TikToker, but I do love Instagram. And I started following hashtags of HRT, menopause, just hot flashes, anything to help. And through so many people that I found online, the excessive weight gain that came on overnight, like 25 to 30 pounds, I felt like just came on within four months. And it was this constant searching on Instagram that I finally felt I found my people. I found information I was looking for. I didn't have to keep asking strangers.

Patient [: 00:12:16

And through there, I found the menopause.org, the North American Menopause Society website.

Patient [: 00:12:27

They changed it to the menopause society.

Patient [: 00:12:29

Now and is where I went. That's where literally, my journey just was. Like, I was running uphill. I went through, I put in my zip code. I found you. Why I selected you. I just kind of read through everybody. Your location and the west loop in Chicago is extremely just liked.

Patient [: 00:12:54

I went to your website. I liked you. But it was our first appointment. I teared up because I felt so heard and so understood, and that from day one of our first appointment, you formulated a plan. But it wasn't just a plan that we were going to stick to. It was a plan that was going to deviate. We were going to work on things that worked for me. And so I feel like you, since we've been just together since February, that we have delved into the estrogen, progesterone, and testosterone.

Patient [: 00:13:34

You had explanations of why I was feeling the way I was. I was on way too much progesterone, which was probably fine at 35, but my natural hormone levels had adjusted, and here I was at 50 on way too much progesterone. You helped me adjust to that in an easy, steady way. We have definitely had our trials and tribs with different progesterones and estrogen and testosterone because not only me personally, my physical makeup, but also we have to navigate insurance.

Dr. Sameena Rahman [: 00:14:13

Right?

Patient [: 00:14:13

And you are so tolerant of that. And to help with that, where a lot of doctors that I have dealt with in the past, again, want that classic, easy patient that is their cookie cutter. They give you ABC, and then they'll say, okay, well, we'll see you next year. And, I mean, we meet monthly or we at least check in with each other. And not only was I looking to just be comfortable and just get through this stage in my life, at this point, I'm not only comfortable, I'm thriving. And I really am. I've lost 27 pounds. I slow and steady.

Patient [: 00:14:57

Balancing my hormones was the first thing. And I'm sleeping better. My hot flashes are actually gone. I really don't have issues. I mean, I'm still having intermittent, even though I have an IUD, I have started to have intermittent periods. And again, I think it's just the hormones, the HRT, adjusting to my personal hormones. But these are all things that I'm not scared of. I'm not like, what's happening, because I have an amazing doctor who is there to answer my questions.

Patient [: 00:15:34

And whether you or your staff, somebody gets back to me, they email me, or we meet so much that I feel like I'm in such good hands, where there are so many friends of mine who are in their 70s, plus a group of women that I'm friends with, and they all just say, oh, my God, you are so lucky we had none of this. And then we have friends in our thirty s, thirty s and forty s. And I have to tell you, sometimes my husband's like, can you just be quiet about menopause? Because when people find interest, they like to talk about it. My husband talks about bourbon, I talk about menopause.

Dr. Sameena Rahman [: 00:16:18

I'm so glad that you do, though. Those 30 year olds are going to be very happy you did.

Patient [: 00:16:22

I agree. These young women say to me, oh, I'm not there yet. I go, but you know what? At some point you will be. And I don't want you to be scared. And I want you to know, if I was 30 and if somebody like me was telling me this, I would remember this. I would listen in. I'm not saying write it all down, but when you start heading there, remember either some things I've mentioned, or hopefully we're still friends and you can reach out to me. But it takes 100%, your own determination, though you have to advocate for yourself.

Patient [: 00:17:01

I will give credit again to my original gynecologist because here it was like ten years later, and I brought up the hormones again. And she once again said, heather, I know all about babies, but I really can't help you. I do recommend start googling. Even my gynecologist at one of the top hospitals here in Chicago, she had.

Patient [: 00:17:24

No clue about, again, speaking to that study.

Patient [: 00:17:26

Any websites anybody to send me to any referrals. So I do feel that in school and a lot of these doctors, that.

Patient [: 00:17:38

There'S no money in menopause.

Patient [: 00:17:42

Just now. The weight loss drugs they're starting to prescribe, those a little more like getting approved, but there's no money in menopause.

Patient [: 00:17:53

Drugs, not right now, specifically.

Patient [: 00:17:57

None of mine is covered by insurance. But because I have a good doctor, you guys help me find pharmacies to work with that are affordable. But currently, yes, there's no money to be made. And that's why I think just the general cookie cutter primary care physician or just gynecologist, they don't see the benefit, even though they're supposed to be there for their patient, the benefit of learning about this, because there's no money in menopause, and that's where I'm at. But again, I'm so glad I have safely landed in your hands and you're stuck with me until I'm 90.

Dr. Sameena Rahman [: 00:18:42

Thank you so much. Yes, well, thank you. I'm happy to take care of you. Heather, I do want to just mention a couple of things you said. So one, with regard to the money and menopause thing, I think now there's so many apps popping up left and right that there's all these menopause apps. So people are diving into it because women like yourself are saying, self advocate, let's do this. And so I think people are listening. Now, I do think a lot of physicians and clinicians are stuck because they're in big healthcare systems where they might be salaried or whatever, and they're supposed to see patients every 15 minutes, which you can't do in a menopause clinic or sexual medicine clinic in 15 minutes.

Dr. Sameena Rahman [: 00:19:20

That's not possible for each patient. You're never going to explain anything or talk to them or understand their journey. So I think that some clinicians are stuck and then others maybe aren't able to go get more education. And some. You're right. It's the other things, though. One thing you mentioned about the study that stopped women in 2002 was the women's health initiative. And so that was the study that both the government funded as well as media put hundred millions of dollars into this campaign to stop women from this hormone because they thought it increased the risk of breast cancer, which we know now is not true.

Dr. Sameena Rahman [: 00:19:58

I'm going to have an expert come talk about that study with me. And so that's going to be in one of my further podcasts. But I think it's really important to state that that study actually was the reason that so many women, their life expectancy changed. We know now that hormone therapy in the right patient population is cardiovascularly protective. It protects your bones, it's good for your sexual function. It prevents UtIs and vaginal estrogen. So, I mean, I think there's so much to be said. And we know that when women fall, when they're older, when you're 80 years old and you fall and you break your hip, that can lead to your demise.

Dr. Sameena Rahman [: 00:20:34

Right? So the estrogen helps your bones. And so I really feel that that study is one of the battles that those of us that do menopause are still constantly fighting to this day. And for patients that meet clinicians that are practicing medicine from 20 years ago, that's what we're running into, right? Like these clinicians are practicing medicine as if it's 2002, which we should not be doing. And the third comment I wanted to make was around the cookie cutter aspect of medicine. And menopause is a very much an individual based medicine. In the North American Menopause society, or the menopause society, we refer to it as precision medicine, because there is no cookie cutter aspect. Your social aspects, your genetics, your other medical issues, everything. Comorbidities really impact whether or not you are a candidate for hormones, whether or not you're going to respond to them, all of these things.

Dr. Sameena Rahman [: 00:21:24

So there is no room for cookie cutter medicine in menopause. And that's why you can't do it in ten minutes or 15 minutes. And that's where we run into a lot of problems from a healthcare perspective. So individualized care is really the forefront of how we should be practicing medicine. And I'm happy to do it, and I'm happy to take care of you, and I'm so happy that you're thriving. And it takes a lot of courage actually to come and actually talk about this. But I do feel that Generation X, we're kicking ass, taking names like we're not pulling up with the BS anymore. So I feel that that is a big part of this menopause movement that's happening.

Patient [: 00:22:04

I mean, I personally understand because you've also educated me. And then the things that I read online, the books I buy, everything, it's not a one and done. That's the other thing. Just because we are on the levels that we're at currently with me, with my estrogen, progesterone and testosterone, doesn't mean that that's going to fit me. In a year from now, I will tell people that listen or listening to this or whatever, that if you feel you're not connecting with your doctor, your gynecologist, whoever you're working with that's helping you, if you feel that you don't have a partnership or that they're not getting you, yes, they're giving you things, but you're just like, they're not really hearing me. I highly recommend find someone else. If you have to have a gap in your service, then maybe that's what you do. Or just immediately start looking.

Patient [: 00:23:07

And again, menopause.org, go to them. Look for a different practitioner. If you have to see multiple people just to find that connection, then do that. It is no different than it is a job.

Dr. Sameena Rahman [: 00:23:24

It's a job and it's a relationship you build. Right? Like it's a relationship.

Patient [: 00:23:28

It is. It's a relationship and you should have mutual respect. It's not that the doctor, they will tell you what to do and you have to do it. That's not what it is. It has to be an equal relationship because I liked what you precision medicine, because it's so precise that just a simple tweaking can send you one way or the other. And that's why it needs to be a good relationship. And you have to feel comfortable to share those idiosyncrasies that you're all of a sudden feeling. And you can't be ashamed and not want to tell your doctor because then that's not helping anybody.

Patient [: 00:24:17

And I think that's it, too. The journey. It is a journey when we meet. Okay, well, maybe the patch didn't work. We got to try the pill. Maybe the pill didn't work. You weren't getting good absorption. We got to try the ring.

Dr. Sameena Rahman [: 00:24:30

You have to go to someone that knows all the options, but also someone that gives you the options, looks at your insurance, what's covered, and says, okay, let's try this together. Midlife women, we know what we want. A lot of us are knowledgeable about what we should be getting, and so there's no room for paternalistic medicine anymore. I don't think that we talk about and educate, but at the end of the day, it's your decision, right? Like, I'm not going to push you to, like, you have to go on hormones. No, but if you want to go on hormones and you see the benefit, and every year we check you and you don't have heart disease or breast cancer or liver disease or things that would make us take you off the hormones. That's why the checks every year. That's why until we find the right rhythm for you, the right medications, the right doses, that until that's found, you really have to keep seeing your clinician and hopefully get to a point where you feel good about yourself, because this is about thriving. This is not about just surviving menopause or it's thriving through life so that you can feel good about life instead of longevity.

Dr. Sameena Rahman [: 00:25:41

People talk about a lot with the blue zones and everything nowadays, but I feel like to get to that point, you really have to be enjoying your life. You can't be suffering through life. So those are all very key, important parts of.

Patient [: 00:25:54

And I can tell how happy I am because again, talk about menopause all the time. I find it fascinating. I find it liberating. I find that it's a new phase in my life. That should not be something swept under the rug and to ashamed we talked about. But we also have to remember, personally, a lot of us don't realize how young it starts, how it does start. In your late 30, it could start at 35 and up. So that's why, again, I kind of talk about it a lot with girlfriends, poor waitresses, servers at restaurants.

Patient [: 00:26:32

If I feel I have a connection, that's amazing. I don't know.

Patient [: 00:26:37

Or if they're like, oh, my God, I can't stop sweating. I'm sorry. And I'm like, how old are you?

Patient [: 00:26:44

That's great. I love that. Yeah, but that's women helping women, right?

Patient [: 00:26:48

We got to do it 100%. We have to help each other. And it also is very. I'm very lucky. I have a husband that's extremely supportive as well. And I think it's just as important to talk out loud with your spouse, your partner, your kids, anyone in your family. Let them know what you're going through, because maybe they can see subtle changes in you as well, whether it's good or bad or whatever. But menopause should not be a solitary affliction that we naturally have to go through and feel that you're on your own.

Patient [: 00:27:26

Because I'm telling you, there is a whole new society of people out there singing it from the rooftops. And it is very exciting. I mean, even since you and I met in February, the changes that have happened in the medicine of menopause, what has even changed this year? So it's very exciting, and I'm thrilled to be here today. I'm happy to discuss all that.

Patient [: 00:27:57

No. And I think it's important for spouses to be involved, and I think it's important for sibling if you know a person that was assigned female at birth and this person will experience menopause either naturally, surgically, and if they live long enough. I think we've talked about this before, that we give puberty talks to adolescent girls. We should be giving peritox to 30 year old women, 35 year old women. They should know what's coming. And so I always try to do the same thing that you do. Oh, you know what? We should talk about the fact that these changes are going to happen and they can be life changing and they can be life disrupting. I mean, their studies are out that people that are experiencing menopause in the workforce have, there's such an economic burden for that.

Patient [: 00:28:43

People are leaving the workforce because of not being able to accommodate their hot flashes, their night sweats, their anxiety, their irritability, whatever, because we know it's mental status issues, too.

Patient [: 00:28:53

I agree. It is so misunderstood in the corporate and corporate environment. So, yes, I do agree. And that's why I believe this should be out there discussed, and it is in this last year. Again, there are commercials on now about it. Again, I'm just happy to be here. I happy to always come back.

Patient [: 00:29:15

We have other issues we can discuss.

Patient [: 00:29:19

And I appreciate you as my practitioner that you are out there on the cutting edge. You're constantly doing new courses and furthering your education or you're educating others in your field. And that's what it. So that's great.

Dr. Sameena Rahman [: 00:29:39

We're all lifelong learners. Thank you so much, Heather. You're amazing. I'm so proud of you advocating, too. I love the fact that you're just out there telling other women what to expect. And there's so many advocacy groups I'm sure you would do well with. Actually, you heard of the let's talk menopause group? Oh, my God. Go to Instagram right now.

Dr. Sameena Rahman [: 00:30:00

I just did a webinar with them on black women in menopause, but it's called let's talk menopause. And they're a really big advocacy group started by menopausal women because of the same reasons we're discussing, like they weren't getting the help they needed. And so they do a lot of great webinars. I think they're doing something in Chicago in May. I'll let you know about that. But I love that you're still advocating. And please continue to do it because women need to hear it and we can't say it enough, honestly.

Patient [: 00:30:27

Thank you.

Dr. Sameena Rahman [: 00:30:27

So I appreciate you. I appreciate everything that you're doing. And I'm so happy that you're thriving and I hope you continue to thrive. And we will probably have you back on because I have other things I want to discuss with you with your journey. But today, specifically, I wanted our listeners to learn about self advocacy in menopause. And I think that you are a prime example of someone that was not going to take it anymore. That was like, I am not taking this. I am going to find someone to help me.

Patient [: 00:30:56

And you did, and I'm glad you did.

Patient [: 00:30:58

Wonderful.

Dr. Sameena Rahman [: 00:30:58

All right, thank you so much. If you have a second, please subscribe to this podcast. I'd love for you to be a follower and learn as much as you.

Dr. Sameena Rahman [: 00:31:06

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Dr. Sameena Rahman [: 00:31:08

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Dr. Sameena Rahman [: 00:31:10

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Dr. Sameena Rahman [: 00:31:12

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Dr. Sameena Rahman [: 00:31:14

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Dr. Sameena Rahman [: 00:31:40

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Dr. Sameena Rahman [: 00:31:41

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Dr. Sameena Rahman [: 00:31:48

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Dr. Sameena Rahman [: 00:31:49

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