July 24, 2024 • 45 mins
Hormones and their role in women’s health have long been understudied, misunderstood, and controversial. Following a new interpretation of the landmark Women’s Health Initiative study, the subject is under discussion more than ever. Dr. Elizabeth Poynor is here to share her expertise. An Ivy League-educated and heavily credentialed surgeon and gynecologic oncologist, her work has been dedicated to midlife women’s health. She also happens to be Martha’s own doctor. Dr. Poynor, now the Chair of Women’s Health & Gynecology at Atria, has seen how crucial hormones are to understanding the overall health and well-being of women. She joins Martha today for a candid conversation about the risks and benefits of hormone support, how to pay attention to the body’s signals, and the science that helps explain “why” lifestyle changes impact the body.
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Episode Transcript
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Speaker 1 (00:04):
Earlier this season, I spoke with several experts about cosmetic
dermatology and the science of skincare. The response was terrific
and thank you very much. Today we're going to continue
to explore medical topics, discussing the latest research, innovations and
health recommendations. Today I am at Newsstand Studios right in
(00:24):
Rockefeller Center speaking with doctor Elizabeth Poynter, a gynecologic oncologist,
an advanced pelvic surgeon, and an expert in midlife women's health.
I've known doctor Poynter for several years and I am
so impressed by her depth of knowledge about women's health.
And just to clarify the situation, she has also been
(00:46):
my gynecologist for several years and I have been extremely
happy with her treatment and with her consultations. So many
are very hesitant to talk about menopause. Many doctors, many
women are hesitanted to talk about a very natural occurrence
in every woman's life. But I firmly believe it's important
(01:07):
to learn as much as possible and to understand how
the changes associated with menopause can affect physical, emotional, mental,
and social well being. Doctor Pointer, welcome to our podcast.
Speaker 2 (01:19):
Thank you so much for having me today and allowing
me to talk about to speak with you about.
Speaker 3 (01:23):
One of my favorite subjects, women's health.
Speaker 1 (01:25):
Well, it's so much more than about women's ability to reproduce. Elizabeth,
I've heard you say that we need to go beyond
bikini medicine. Can you tell me what you mean by that?
Speaker 2 (01:37):
So women have distinct physiologies from men, largely dictated by
fluctuating hormone levels throughout the month and throughout our lifespans.
So we know, and we've known for quite some time
that women are not small men. However, there hasn't been
a lot of work devoted to this or a lot
of research relating to this, And now we're just at
a pivotal moment where we're beginning to realize the importance
(01:58):
of specific female physiology and it needs to be studied
and entreated and looked at very differently through a different lens,
a hormonal lens.
Speaker 1 (02:06):
And you, as an expert, know a lot more than
most of us, because for the record, I've been on
hormone replacement since I was like forty years old. That's great,
and you want to know something, I think it is great.
I think it has kept me more vital, more healthy,
more my bones stronger. If that's true, I'm not sure
(02:27):
if that's just genetics or if it really has been
helped by my hormone replacement.
Speaker 2 (02:32):
Definitely for women, when hormone replacement, usually consisting of estrogen
or estrogen plus progesterone, started within a few years of
menopause or in that perimenopausal transition or before the age
of sixty, you're really going to get great benefits from it.
You're going to get cardiac benefits, cardiac protection, bone health protection,
of course, maybe even brain protection.
Speaker 1 (02:51):
That data I certainly hope. Yes.
Speaker 2 (02:54):
So it's great that you started early and had physicians
who were engaged and who actually did that foil years.
Speaker 1 (03:00):
It was because I had a lower abdominal hysterectomy after
the birth of my daughter, I developed fibroids or something
like that. I don't know, I can't you know. That
was a long time ago, and the doctor said, oh,
it'd be best if you just had this procedure and
then but he started me immediately on hormone replacement. It
was primarily progesterone and a little bit of justeosterone. I think, so.
Speaker 2 (03:24):
Before the Women's Health Initiative study that was very standard.
Kind of the advantage of being an older physician is
you get to see the history of medicine and the
history of trajectories and how we treat people. And when
I first started in surgical oncology, when we would remove
ovary's or do a hysterectomy with ovaries, we would always
recommend hormone support to protect the heart. The Women's Health
Initiative Study was published and came out in two thousand
(03:46):
and two and really took that off the table for
a lot of people, and a lot of doctors then
became very scared to provide hormone support for their patients
before well the study was the interpretations of the study
were prematurely released, right.
Speaker 3 (04:00):
We looked at the Women's.
Speaker 2 (04:01):
Health Initiative Study included one hundred and fifty thousand women
who were as young as in their forties and as
old as seventy nine, and they were randomized to either
be on hormone support or no hormone support. And what
we found is the risk of cardiac disease and breast
cancer was higher. But remember we were starting women far
after the transition of menopause. These were women who were
in their sixties and seventies, who were more than twenty
(04:23):
years for some of them probably after menopause. But when
we did a subset analysis, meaning we took and we
looked at specific populations or groups of women within that study,
we found that if hormones were started early in that
perimenopausal or menopausal transition, that you actually did gain significant
cardiac benefit from paramant support and decreased our death from
all causes actually other than breast cancer, which was slightly
(04:45):
elevated in this study.
Speaker 1 (04:47):
And not all surveys are the surveys that we need.
Speaker 2 (04:51):
We need to interpret studies the appropriate way just because
something is published and we need to look at how
to interpret it, and we have to be intelligent about
how we interpret it.
Speaker 1 (04:59):
Now I'm looking I had a very beautiful, slender, chic,
short skirted, long leggage, high heel wearing Guya colleges.
Speaker 3 (05:09):
Kay, I'm coming back here more often.
Speaker 1 (05:10):
When I first met doctor Porter, I thought she was
maybe the office assistant on a summer break from college
or but here here I am sitting next to a
very beautiful female doctor with long black hair. How do
you keep in shape like this with your horobably difficult schedule.
Speaker 2 (05:28):
Well, I practiced what I counsel my patients. I started
on hormones when I was forty three. I had some
new mood issues actually around the age of forty three,
and I was doing very large surgical oncology cases and
kind of hand ringing a little bit and developed some anxiety.
Speaker 1 (05:42):
Was your son born then?
Speaker 2 (05:43):
Note he was born. He was about a year or
two after he was born. And it was my mom
who said, oh, I think it might be your estrogen.
And so I actually started on hormone support due to
some anxiety, which was I'm now in retrospect, was definitely
the perimenopausal transition. And this is before anybody really reconnized
that anxiety or depression was actually linked to perimenopause or
(06:04):
menopausal transitions. So I started early on hormone support, and
I think it's kept my metabolism good. And I practice
what I speak about in terms of nutrition, exercise, lifestyle,
healthy sleep, good outlook, all those things that helped to
keep us young. So I try my hardest.
Speaker 1 (06:20):
There are men who will say, oh, she's in a
bad mood today, she's in menopause. Probably men are telling
me this and I mean, what do they know about menopause?
Speaker 2 (06:30):
Well, we need to educate them more. And I think
you're aware. My husband is a breast surgeon, and so
when I was starting on hormones, my husband is very
knowledgeable obviously about breast cancers. Like, no wife of mine
is going to start on hormones because of the breast
cancer risk.
Speaker 3 (06:44):
And we can talk more about that, and I hope
we do.
Speaker 2 (06:46):
But he went to all the best medical schools, had
all the best training, knew nothing about menopause, knew nothing
about hormonal transitions, and was like, this.
Speaker 3 (06:54):
Is no joke.
Speaker 2 (06:54):
And I'm like, yeah, no, it's not a joke in
terms of the changes that we go through. But I
think there's more conversation now. There's more out on social
media about menopause. There's certainly more in the popular press
about menopause, and so now individuals are men and women
are realizing that anxiety or depression or mood issues are
tightly linked to hormonal fluctuations.
Speaker 1 (07:14):
Now once on hormones, now I've been on hormones for
a long time. I started like right in my early
forties too. Does your treatment have to change? How do
you test for hormonal balance and everything.
Speaker 2 (07:27):
So this is the tricky part about hormonal management. Naturally,
we will need to change hormone dosing over an individual's lifetime.
If you still have your ovaries and you're transitioning through
perimenopause or into menopause, the ovaries don't just decide one
day they're going to turn off. They naturally decline, and
so we may start on lower doses of estrogen, we
may start on doses of progesterone with odd estrogen or
and then naturally anticipate that they will need to be
(07:49):
escalated over a woman's lifetime and then maybe drop down
a little bit when we get a little bit older. Actually,
so that this is a conversation and dialogue that every
woman should have with her physician or the person who's
helping her manage her hormones, because it's really a communication
because what works for one person doesn't work for everybody.
So it's very highly personalized medicine.
Speaker 1 (08:10):
I don't usually talk to people about their treatments or
medical treatments, but a couple of my very close friends
have spoken to me like, oh, why do you have
such a nice skin? And I say, I think it's
because of the hormones I taken, and of course genes,
but and I said, do you take hormones? And most
of them, most of my friends, have never been on
(08:31):
hormone replacement.
Speaker 2 (08:32):
So about that period of the Women's Health Initiative Study
when it came out, and I remember this, I mean,
we sent letters to our patients. At the time, I
was at Slung Cattering as a surgeon, and we sent
letters to our patients, you know, stop your hormones immediately.
We were very couscormed about it. Stop them immediately. Well,
about fifty percent of people went back on hormone support. Actually,
so fifty percent has significant symptoms off of hormone support.
(08:55):
So everything with the Women's Health Initiative Study came from
a screeching halt because it was just a knee jerk
reaction because there was an elevated relative risk of breast
cancer with this type of hormone support that was prescribed
in this study, everybody to stop their hormones. And instead
of throwing out the drugs and saying, okay, these drugs
might not be the safest that we could use, we
(09:16):
actually throughout the issue. We threw out menopause and said, well,
there's nothing we can do for you because this Women's
Health Initiative study came out. You can't take hormones, they're
not safe. But we have newer preparations now that the
French have had for a number of years, longer than us,
that are actually safer than our older preparations, and this
is now being brought to the forefront, so we have
instead of saying we can't do anything, we now have
(09:37):
safer preparations to treat with well.
Speaker 1 (09:39):
Most discussions around hormone therapy is about relieving symptoms of menopause,
but they must affect so many other parts of our health.
I mean, they must help so much more in bone
strength and good hair.
Speaker 3 (09:53):
Is that true? Absolutely?
Speaker 2 (09:54):
There's estrogen receptors all throughout the body. I mean we
could talk from the tip of your head down to
your toes, to the muscle, bones and joints basically. So
there's estrogen receptors in the brain that are increasingly being
identified as being important actually and maintaining cognitive function for women.
Speaker 3 (10:10):
In terms of estrogen support.
Speaker 2 (10:12):
It was recently published that around the time of perimenopause,
estrogen receptors are those hearts of our cells that hold
on to estrogen actually increase at the time of perimenopause,
and there's some data out that really suggests that women
who are on early hormone support within three years of
menopause actually have improved cognitive function and may have a
decreased risk of dementia. Overall, that's the brain, cardiac health.
(10:34):
We know that there's a thirty percent reduction in all
cause of mortality other than breast cancer with hormone support,
and that's thought to be largely through cardiac risk. Skin
definitely increases, collagen production, decreases fine lines and wrinkles. There's
data in the literature that few people review and discuss
that even with topical estrogen we can improve skin muscles. Well,
(10:54):
of course we are muscle mass changes when our estrogen drops.
It can also drop and decline as estra levels decline.
Bone health has been recognized for many years that as
estrogen declines, bone health deteriorates, and we can help bone
health by adding back estrogen. So really and metabolism also, right,
So when estrogen levels start to decline, we begin to
develop metabolic disruptions. So you can look at every organ
(11:17):
system in the body basically and have some link to
hormone fluctuations in terms of the health of that organ system.
Speaker 1 (11:23):
So what happens to the woman who has a brisk
cancer history in the family, what do you tell her
about taking hormones.
Speaker 2 (11:30):
So a family history of breast cancer without a personal
history of breast cancer is not an absolute contra indication
to hormones. Even with our highest risk individuals in terms
of genetic mutations, we will many times speak with them
about hormone support after ovaries are removed and recommended. Actually,
so I think every individual in every situation is to
be personalized, but a family history of breast cancer is
(11:52):
not a contraindication to hormone support.
Speaker 1 (11:54):
Are you writing about this too?
Speaker 2 (11:56):
Oh yeah, oh yes, yes, So we're working in a book. Definitely,
we're writing about this.
Speaker 1 (12:01):
When is that book available, Probably.
Speaker 2 (12:03):
Within the next eight or nine months. We want to
offer you solutions and how you can age beautifully and
be vibrant just as you're doing.
Speaker 1 (12:11):
I have so many friends who need this book, so
good luck with it. I can't wait. I can't wait.
Thank you. You'll have to come back on the podcast
to talk about the book. So what innovations are you
seeing about when it comes to the science of managing
(12:33):
and treating the symptoms of MENOPAUSEA when do you know
that you're in menopause? When? How do you know?
Speaker 2 (12:39):
So menopause is really defined as being postmenopausal as you
don't have I haven't had a period for a year.
But that's an antiquated kind of definition, right, because that
definition was before we had laboratory testing. Everybody kind of
forgets you know, one hundred years ago we weren't able
to check for these levels of bollicle stimulating hormones and
asterrodial level. So menopausemeaus you haven't had a period. And
when your post menoposamis you haven't had a peer in
(13:00):
one year. Perimenopause is that time leading up to menopause.
And then perimenopause really can start anywhere between eight and
ten years prior to your final menstrual period.
Speaker 1 (13:11):
So women, that's an elongated right in a bad mood? Well,
I mean that's what you hear. Everybody is in a
bad mood.
Speaker 2 (13:19):
Think everybody reacts differently, right, I mean, I think everybody
has their own different types of issues as their hormone
levels fluctuate. And that's actually an interesting question is in itself.
Why are some individual symptomatic and others not right?
Speaker 1 (13:30):
And could that be also because if they were taking
hormones maybe that would prolong good health or of course,
and that's when I phone the actual menopause.
Speaker 2 (13:39):
Right, that is one of the big questions that I
have actually just as a practitioner. If we start hormones earlier,
can we stave off some of these cognitive changes that
we see because right at the time of perimenopause and menopause,
we see real changes in the brain. The brain size changes,
the blood flow changes, the metabolism change them. You can
see it on scans. So if we start hormones earlier,
especially at women who maybe elevated risk of cognitive issues
(14:02):
and that type of thing, if we start earlier before
fluctuations really set in, can we actually stave off these
issues even better? And those are big questions right now
that are not just now being asked and beginning to
be answered based at a basic science level and at
a clinical level also.
Speaker 1 (14:16):
So are you giving brain scans to women now on
a regular basis?
Speaker 2 (14:21):
There are research protocols where people are beginning to do that,
looking at MRIs of the brains, looking at brain size,
brain processing, this type of thing, and that's very kind
of elevated testing.
Speaker 1 (14:32):
What about physical tests physical.
Speaker 2 (14:34):
Test Well, certainly in terms of cognitive testing, there are
definitely physical testing. But by the time you have manifested
any of these physical symptoms, and I'm just talking about
brain health as an example, we could talk about every
organ system. But the time you've manifested, you are transitioned
into a disease state. So we want to keep you
from transitioning into a disease state. We want to cut
we want to prevent anything.
Speaker 1 (14:54):
Early detection, early examination is best.
Speaker 3 (14:57):
Yeah, and early prevention.
Speaker 1 (14:58):
So like what age would you say a woman and
should start really considering this?
Speaker 2 (15:02):
So I think you know, women between the ages of
thirty five and forty can begin to see significant hormonal
fluctuations and really need to pay attention to their symptoms.
Right now, we don't have great laboratory testing. Again, this
is an area that I'm super interested in, is can
we really begin to define when estrogen levels start to
fluctuate or progesterone levels start to decline with our current
testing that's really well accepted. We're not really there yet,
(15:24):
and we have to listen to narratives, And this is
why doctors need and physicians and healthcare providers really need
to listen to the patients that they're caring for about.
You know, may have a little more anxiety, like some
of the earliest symptoms of actually hormone changes, a little
bit of anxiety, maybe a little shape shifting. You don't
even have to gain weight, you just get a little
thicker in the waste. That may represent an accumulation of
(15:44):
what we call visceral fat, which happens as estrogen levels
start to decline. May have a little new anxiety, libido
issues actually or early worn early symptoms of estrogen fluctuations,
vaginal dryness at certain time points of the month, actually
a cycle maybe, So we need to listen to our
narratives of our patients to really kind of determine where
they are in this transition. And then it'd be great
(16:07):
to have some laboratory testing too.
Speaker 1 (16:09):
And women should be a little bit more open with
their doctors. I would say, are women are still a
little shy? I think sometimes I think so physical being.
Speaker 3 (16:18):
I think some that's changing.
Speaker 2 (16:19):
I think thanks to social media and the internet and
more conversations. You know, I realized during COVID actually that
when we were having these kind of anonymized zoom meetings
and things like this with patients and speaking groups, that
women talked a little bit more freely. And now they
can get information a little bit more easily, so they
might become a little bit more open. And this generation
of women now who are transitioning through menopause are very
(16:41):
open about it. And that's great because that's bringing all
of this conversation to the forefront and helping women to
open up about it. But still you still have to
elicit and ask questions, do you have pain with intercourse?
Do you have vaginal dryness? People don't always volunteer that information.
We have specific questions that we ask our patients.
Speaker 1 (16:58):
So it's up to the doctors as well as the
patient's Absolutely we have overt and uh open about all this.
There's so many other questions to ask a guidecologist of
your stature. What is the current guidance on frequency of mamograms?
Speaker 2 (17:12):
For example, most professional societies actually recommend a yearly mammogram.
Still AI is going to help that, I hope actually
in terms of in terms of looking for pattern recognition,
I mean, AI is like so great looking at pattern recognition, Like,
we're at a point now where we can look at
an EKG and this was just brought to my attention,
and that AI group can look and that the machine
learning can look and say it's a male or female EKG.
(17:34):
There's no physician who can do that. So now we
have all this great pattern recognition. So this is really
going to contribute to our screening. But most people still
recommend a yearly mammogram and of course a breast ultrasound
if you have dense breast and if you're at elevated risk,
consider a breast MRI.
Speaker 1 (17:48):
And what about pap smears.
Speaker 2 (17:50):
Pap smear is a little bit less on the guidance
in terms of the frequency is recommended now every two
to three years if you haven't had an abnormal pap
smere or HPV negative testing every five years if you're
over the age of thirty and HPV negatives.
Speaker 1 (18:03):
So I used to be every visit right.
Speaker 2 (18:06):
But there's guidelines are for population health, right, and so
it's always like I always, I think it's a conversation
between the individual and the person who's taking care of them.
Speaker 1 (18:16):
Of course, copies seems like everybody is prepping for a kolonoscopy.
Speaker 3 (18:22):
Well, so colonoscopy.
Speaker 2 (18:23):
We've decreased the age of recommendation of kolonoscopy down to
forty five. That's because we're seeing aggressive colon cancers and
younger people. We're not quite sure why, but definitely colonoscopy
has remained the gold standard. But there's also there's liquid
tumor biopsies looking for fragments of tumor DNA in stool
samples and such, and also in the blood. And so
(18:43):
these screening modalities are also poised to contribute.
Speaker 1 (18:47):
To mail order stool samplings. That right, I mean you
could just you can just put some poop in a
in a tube and send it off in the mail.
Speaker 3 (18:55):
Right.
Speaker 1 (18:55):
Are those accurate?
Speaker 3 (18:56):
They are very accurate.
Speaker 2 (18:58):
They are not well accepted for an individual who is
known to be at elevated risk, such as.
Speaker 3 (19:03):
A family history or a pre do that, you know,
they're extremely accurate.
Speaker 1 (19:09):
They're a little scary to me.
Speaker 2 (19:11):
The easier that we can make a screening test for
somebody and the less invasive that it will be, the
more acceptable that it will be. Overall, and so, and
I think again we're moving as we get as we
have more molecular diagnostics.
Speaker 1 (19:24):
And I always worry about the temperature, and if it's
one hundred degrees outside, well, any symptoms disappear, you know,
That's what I think about if it's in the mail.
For us, ever, are sitting in a hot truck for
four days, right.
Speaker 2 (19:34):
We're looking at fragments of DNA and such, and so
that's pretty stable.
Speaker 1 (19:38):
Actually that's stable. Yay? Stable? So can you break down
by decade? This is a this is a kind of
a hard question. How should women adjust their medical routines
and health habits. Let's just say in their late thirties forties.
What do you do then?
Speaker 2 (19:53):
So, for for many women in their late thirties, they're
completing child bearing if they've chosen to have children, and
are focused less on reproduction and more on now focusing
attention a little bit to their own health. And some
of us need attention, need to do that, and because
we all have busy lives or we're taking care of children,
or we're taking care of our families, or we're working.
(20:14):
But this is a time after child bearing, right to
really begin to focus and focus on health. And that
is healthy exercise, making sure that you move every day,
healthy nutrition, staying socially engaged, stress management, paying attention to
sleep for a lot of people, which is also very difficult.
But you know, late thirties early forties time to just
(20:35):
establish your patterns and patterns of good health and also
listen to your body. What's your body telling you? You know,
we don't talk as physicians about this enough. Like your
body will speak with to you a little bit. Sometimes
it whispers, but it'll tell you when things are a
little bit of wry or not wrong. So I always
try to tell women, you know, if you feel like
something's not right, bring it to the attention of your physician.
So thirties and forties are where you're started to listen
(20:56):
to your body and establish good health habits and get
into the to the routine of making sure that you
get a yearly exam. See you see your physician once
a year, have your lipids checked, have your hemoglobin A
one seed checked, find out what your baseline is and
where you're starting from, and then grab onto some good
health habits to age with strong and what you do.
(21:16):
So fifties are a time where really estrogen levels are
really declining, and so thirty five to forty to to
the late forties, right, we're starting to we see estrogen fluctuations,
but we really see estrogen levels start to decline in
the early to mid fifties. And so again that's paying
really close attention to your symptoms. Knowing your family history,
know your family history of cardiac disease, know your family
(21:36):
history of dementia, speak to your health care provider's hormone
support right for you. Paying attention to maybe not feeling yourself.
I always as my patients, you know, do you have
you lost your JOI de v You know, you might
say I'm not, I don't have anxietyor depression.
Speaker 3 (21:49):
But you might say, you know, I don't feel like myself.
I don't.
Speaker 2 (21:52):
I don't have the same confidence when you while I
walk into the boardroom, Am I having any word finding difficulty?
It's really about how am I enjoying my life?
Speaker 3 (22:00):
You know?
Speaker 2 (22:00):
These are all just very subtle things that we as
physicians don't always ask, but these are important things to
ask yourself. And then if you have any of these
issues and they're new for you, something that's new or
different from you needs to be addressed. Actually, sixties sixties
that's a time to really double down. I think on nutrition, exercise, mindset,
stained socially engaged, making sure you have a great sense
(22:22):
of purpose.
Speaker 3 (22:23):
Of course, having all of your testing that.
Speaker 2 (22:25):
You would normally have with blood test, I failed to
mention a coordinary calcium score. But know your family history
of cardiac disease super important. But consider advanced testing in
terms of more advanced cardiac testing in the fifties and
early sixties, pay attention to that, of course. Also the
sixties are where we have to, I think, make a
real concerted effort, Like I am going to exercise every day.
I'm going to do one hundred and fifty minutes of
zone two cardiac. I'm going to do strength training three
(22:47):
days a week. I'm going to make sure that I'm
eating enough protein because we tend to lose muscle masses
we age, so we want to make sure we ramp
up the protein, decrease the carbohydrates. Maybe a little bit
in nutrition a little controversial with that, yeah, but definitely
ramp up the proteins. And how you adjust that with
your carbohydrates, that's your choice, but.
Speaker 3 (23:06):
Definitely ramp up on protein.
Speaker 2 (23:07):
And then I think it's really like I said, sleep
is really important, becomes a little bit more difficult to
sleep as we age, and so what.
Speaker 1 (23:13):
Should one do about that? I mean, this is so
many people are talking about, Oh I can't really sleep.
I can't.
Speaker 2 (23:18):
One thing that's really important is realize that sleep is
an active process. Realize that it's something that's really important.
It's not like you just go to sleep and your
body's not doing stuff. It's doing really important stuff, right,
So scheduling sleep, making sure and we all know sleep hygiene,
you know, turning screens off, giving yourself an hour of
wind down, you know these things. But also I think
it's really important just to get in that mindset of
(23:39):
training your body to realize that sleep is important. And
also I just recently got an aura ring. You're supposed
to wearing a four PingER. I get data on my
ring finger. But what that showed me which was really interesting.
I mean I have a million degrees from all these
Ivy League educations, and I didn't realize that being in
bed does not mean that you are asleep, that you
are sleeping exactly, or a ring gives you or any
(24:01):
of these wearables whoop or any of these give you
insight into if your sleep is disrupted.
Speaker 1 (24:06):
Or by the way is, Oh, you are a and
I just got one. It was too small for me.
So I'm waiting for my new one to come because
i want to wear it on my forefinger. It is,
and I want to I'm dying to see what my
horrible sleep habits.
Speaker 2 (24:21):
It will give you a lot of insight and then
you can see, like, you know, does a little bit
of wine the night before does it disrupt my sleep?
And you'll be amazed that like two ounces of wine
will actually lead to some sleep disruption or you know,
I'm always amazed at the heart rate variability actually correlates
with my stress.
Speaker 3 (24:39):
Actually, it's really so. It gives you good insight into
when you sleep better? What did I do the day before?
Speaker 1 (24:46):
What to do correct exactly? That's what I'm looking forward
to to really determining with mine. So what should we
do in our seventies.
Speaker 2 (24:54):
I think similar to the sixties. I mean, you just
you really want to make sure that you are really
focusing non nutrition, exercise, sleep. I think even more so
sense of purpose and social engagement becomes really important in
the seventies. I think that we need to you know,
we live in I always say it's a great time
to get being getting older in our society right now,
(25:16):
because I love all the older Instagram accounts, I love
the older the magazines that are for individuals post fifty.
I think it's really great. In the past, we wouldn't
have seen these.
Speaker 1 (25:25):
Public AA and what else.
Speaker 2 (25:27):
Yeah, oh, there's there's a few others actually that don't
have retired in the.
Speaker 1 (25:30):
Title because AARP is like that retired shouldn't be there,
because yeah, I encourage people never to retire.
Speaker 3 (25:37):
I'm not retiring. No, yeah, don't Yeah, I'm not retired never.
Speaker 2 (25:40):
But I think that's why that sense of engagement and
purpose becomes really important, because a lot of us will
exit the working fields, and I think that we have
to really focus on community, sense of engagement, sense of purpose.
These are all if you look at the common denominators
of individuals are centurions, and they are people who have
a great sense of purpose, a great sense of optimism.
(26:01):
They remain socially engaged. So got to do all the
other good stuff with nutrition exercise. Protein exercise becomes even
more important because you want to really maintain muscle mass
and don't want to become frail, and because that has
its own set of issues. But that maintaining of that
social structure is so important and sense of purpose is
so important, and then eighties, same thing, really the same thing,
(26:23):
and I think, you know, just really maintaining that all
those great health abb is that you established.
Speaker 1 (26:29):
It's harder and harder to find doctors to take care
of you as you get older. Being involved with the
Center for Living at Mount Sinai, I learned that geriatric
medicine is a medicine that for a while fill out
of favor because doctors didn't want to deal with elderly people.
But now with the aging population, it's starting to become
(26:50):
a more interesting field of endeavor for doctors. So I
hope more and more go into geriatric medicine because we
need to really deal with all of those as we
get older and not feel bad about getting older.
Speaker 2 (27:03):
It's great to get older. You want to age strong.
You want to be you want to age with strength.
That's the title age strong. You want to be strong
as we because you're getting older. The opposite is no good, right.
You want to get older. You want to be chronologically
older and biologically fit and a little bit younger. And
I think that this is a great time. I'll always
say it. I think we're aging with more optimism now,
(27:24):
and I think we're on the cusp of really changing
that whole approach to medicine for older individuals.
Speaker 1 (27:31):
When it comes to longevity medicine. Are there specific considerations
for women that would be different from men.
Speaker 2 (27:38):
Totally in terms of longevity. You know, we're just now
realizing the importance of estrogen to basic issues such as dementia,
cardiac disease, and cancer. Right, these are the three things,
the three issues they associated with aging. Mitochondrial support and
inflammation are issues as we age, right, or mitochondria aren't
as strong. Those are the little powerhouses that make energy
(27:58):
in ourselves, and we have more inflam so we really
need to pay attention to ways to mitigate that.
Speaker 1 (28:02):
Well, how do you because inflammation, I think is a
big problem. I feel it.
Speaker 2 (28:07):
Yeah, that is a strong foundation in nutrition, exercise, good mindset,
keeping your cortisol levels lower, so managing stress super important.
Speaker 3 (28:16):
And then I'm going to say.
Speaker 2 (28:17):
It estrogen, right, because estrogen is an anti inflammatory, it's
an antioxidant, so that will definitely help. There's some evidence
that actually estrogen directly impacts on the mitochondria. So what's
new in longevity medicine is that we're we.
Speaker 1 (28:30):
Are remembering that word everyone medachondria.
Speaker 3 (28:33):
Yeah, that's really important.
Speaker 2 (28:35):
They're what we're realizing is that women and men are
different and and that will translate over at the cellular
level also in terms of how we respond.
Speaker 1 (28:43):
Tot Oh, of course, that's what I want to know.
Speaker 2 (28:50):
I think, you know, women, so women live tend to
live longer than men, but we live currently we still
live in more years of being unhealthy. We have fewer
years of active health than men.
Speaker 1 (29:01):
Do.
Speaker 2 (29:01):
We really have to get to the bottom of that
and why that occurs. And that's you know, because we
didn't have women in research until nineteen ninety three and
I AGE did it and mandate at female animals until
twenty sixteen. So we live more years in poorer health
than men, but we tend to live longer. But the
idea is to get us to get to better health.
Actually for those all of those years.
Speaker 1 (29:30):
Let's get real about midlife metabolism and women. What happens
to our metabolism as we age?
Speaker 2 (29:36):
So as estrogen levels go down, we do this shape shifting, right,
so we begin to deposit fat in the visceral areas
or the abdominal areas, so around your liver, around your heart,
and your stomach. Basically, so the fat are adipocites that
live in the hip region and buttock region actually begin
to not migrate, but shifts into to the visceral area.
(29:59):
That becomes an flammatory and then that leads to what
we call insulin resistance, so we have metabolic disruption, so
and that also leads to more inflammation. So it becomes
a vicious cycle of low estrogen levels, visceral fat deposition, inflammation,
more visceral fat deposition.
Speaker 1 (30:14):
Meno pot.
Speaker 2 (30:16):
I wouldn't use that term because I am a professional,
but there is that term that is definitely circulating. Yeah,
I wouldn't use that, but that is definitely circulating around
and that does refer to our waste to hip circumference
ratio increases, and that's actually a better measure of what's
going on in our body because one term that we
do use is called skinny fat.
Speaker 3 (30:36):
You can be abnormal weight.
Speaker 2 (30:38):
Or of normal BMI, but all of that fat can
be in your abdominal area and that's unhealthy and that
leads to this what's called insulin resistance and weight gain.
Speaker 1 (30:48):
And eat of watermelon a day. I just read that's
a new hack. Just eat a watermelon a day and
you will not ever get fat in your stomach. Well,
that just came over the you know, that was on
the Instagram the other day.
Speaker 2 (31:03):
But that reminds me of the old pineapple diet for
the nineteen seventies, of which I ate so much pineapple
that my mouth was about to fall off. So yeah,
I don't think eating a watermelon a day.
Speaker 1 (31:11):
I don't either. But sleep habits are of ultimate importance.
Speaker 2 (31:17):
Sleep is really important. Sleep is really important to cognitive function.
Less sleep equals worse cognitive function, it equals higher when
people who don't sleep have a higher risk of dementia.
It is, like I said, it is an active process.
We're clearing our brain waste products. There's a whole system
where the way lymphatic fluid circulates around the body at night.
Speaker 1 (31:37):
So you think that when you're sleeping, all that is
going away.
Speaker 2 (31:40):
There is, there's active So it's an active process. It's
like it's an active process.
Speaker 1 (31:45):
It's not bunk, as my grandfather would say.
Speaker 2 (31:48):
No, And it's really really, really important. And I actually
did a course for a malpractice carrier recently, and it
was all about sleep and cognition and cognitive function. And
there's been a lot of studies and physicians that we
make poor diagnostic when we have less sleep, and it's
really so there is an activity that is going on
in our brain as we sleep.
Speaker 1 (32:07):
Is there a connection to cardiovascular health? How lipids and
cholesterols start to change at this age and beyond.
Speaker 2 (32:14):
Certainly in terms of there's a link to sleep in
cardiovascular health because when we don't sleep, where we live
in an inflame state, and that's actually bad for cardiac health.
And in terms of cardiac health and lipid metabolism are
extremely linked. And at midlife our lipids change in our
cardiac health changes.
Speaker 1 (32:29):
So what are some no nos in terms of diet
for anti inflammatory?
Speaker 3 (32:35):
Get rid of processed food.
Speaker 2 (32:36):
So anything that has more than three ingredients on it
is probably a processed food. Shop the periphery of the supermarkets.
Eat freshole food and don't use added sugars. Sugars are
super super inflammatory. The sugars that you get in fruits
and berries actually are fine because they come with fiber,
but the sugar that's just added into something is not
good at super inflammatory.
Speaker 1 (32:56):
So you don't eat any sugar.
Speaker 2 (32:57):
I really minimize it, really pay attention to that chocolate,
dark chocolate. Dark chocolate's great for your brain, good antioxidants.
So no, no sugar.
Speaker 1 (33:06):
Coffee.
Speaker 2 (33:08):
So there's one hundred studies trying to prove that coffee
is bad for you, but no studies have shown that
it's really bad for you. They tried to link it
to pancreatic cancer at one point that was not successful.
So I can't find anything bad about coffee, and coffee
has antioxidant's good for your brain.
Speaker 3 (33:21):
Especially teas are okay. Also same thing.
Speaker 2 (33:24):
You just have to watch out for your caffeine content,
especially with teas. Also, you just want to drink a
tea that's caffeinated too close to sleep because that can
really be a disruptor for your sleep.
Speaker 1 (33:34):
Diet coke, oh.
Speaker 3 (33:37):
So yeah, that would be a processed food.
Speaker 1 (33:39):
More than three ingredients. Those are the things that people forget.
They think that that's just water.
Speaker 2 (33:45):
Yeah, and you have to look at artificial sweeteners and
the impact that they have. A lot of physicians, especially surgeons,
have big diet coke habits. And I stopped diet coke
a while ago, and when I was actually stopping drinking it.
I actually had like some mood issues and I was like,
this is so weird. I'm like, everything's great. I shouldn't
have any mood issues. And then I start reading about
I was like, oh, I'm withdrawing from all the aspartame.
Speaker 1 (34:06):
When I read about artificial sweeteners or actually, my daughter
pointed it out to me. She had listened to an
interview with the man who invented an artificial sweeteners, the
most popular one, and he said that if he could
do it all over again, he would never invent it. It's
interesting because it's so dangerous for the human health. But
(34:27):
I don't use a lot of sugar, but I do
like dessert.
Speaker 2 (34:30):
So there's a ninety percent rule, right that we have
got to enjoy life, right, you know, just don't need
a lot of chocolate cake or eat a lot of
cake all the time.
Speaker 3 (34:37):
You know, but what do you use? It's nice to enjoy.
Speaker 1 (34:40):
Every now and then. So how do we deal with
mental health and mood and women's health.
Speaker 2 (34:48):
I think that we need to be really attuned to it.
And this is where as health providers and specialists in
women's health, we really need to key in on that
that so just can be a simple question about how
are you feeling? Are you feeling any different? How are
you feeling? That goes back to those JOI de v questions,
And I do think that we need more mental health
providers that are keyed into midlife women's health and really
(35:11):
understand these changes that occur because estrogen and progesterone really
do affect the neurotransmitters. I mean, there are real issues
that are medically happening in the brain as estrogen levels
are fluctuating. We see that also in women before midlife
with PMS and PMDD and postpartum depression, and the treatments
of these issues and recognition of these issues definitely warrant
(35:33):
further study and for their higher numbers of individuals involved
in these specialties.
Speaker 1 (35:37):
Is it true that women are at higher risk for dementia?
Speaker 3 (35:40):
Yes? Two thirds of Yes, totally.
Speaker 2 (35:42):
And this is one area that I'm super interested in
actually and is gaining in popularity in terms of interest,
And because why is that? Is it hormone fluctuations? Is
our lifestyle what makes us more susceptible intimasions? A lot
of individuals are looking at the role of hormones on
the female brain, and we are moving in that direction.
Lifestyle factors are also being looked at, but that research
(36:05):
is really accelerating and it's super exciting. And this leads
us back to, you know, can we identify women who
are at high risk and then get hormone support or
lifestyle support initiated earlier?
Speaker 1 (36:16):
Are there lifestylent interventions that one a woman can take?
Speaker 2 (36:20):
Absolutely anti inflammatory nutrition, making sure that you have your
homoicystine levels checked, which is inflammatory for the brain and
the heart.
Speaker 1 (36:28):
Good stress who does that? Who?
Speaker 3 (36:31):
Generalists can do that? Check? You can add what is
it's a blood test?
Speaker 2 (36:34):
There?
Speaker 3 (36:34):
These are blood tests and is what do you ask for?
Speaker 2 (36:37):
I would ask for just a general metabolic panel. I
would ask for homoicysteine levels and that's not all generalists
will do a homicistine level but super important, super and
I think that we are at elevated risk for dementia
and cognitive issues, so we need to be a little
bit more aggressive in our female population. But definitely early
identification of individuals who may be at elevated risk and
(36:59):
warrant more intensive interventions. And then for individuals who are
not deemed to be at risk. We are all at
risks because we're all women, you know, so, but just
paying attention close attention to lifestyle factors and those subtle
hormonal issues that you know. And one of the first
signs of perimenopause is like word finding difficulty. Sometimes I'll
ask people, you know, is your memory off, and they'll say, no,
(37:19):
it's not really often. So are you having any word
finding difficulty?
Speaker 1 (37:21):
Oh?
Speaker 2 (37:22):
Yeah, I can't remember names the same way. So what
we what we call associative memory or coordinating like like
things or faces and names and such starts to go
off a little bit and word finding goes off a
little bit, and that can be correlated actually with real
changes in the brain structure. So these are active areas
of research and are just.
Speaker 1 (37:41):
What can one do about that?
Speaker 2 (37:43):
Again, review it with your position. Maybe are your healthcare providers.
Speak to your provider about maybe starting on hormone support
earlier if you're considering it. And I think this is
one one thing that I'd recommend to people. Also kind
of get your opinion on hormon support. Are you going
to go in that direction?
Speaker 3 (37:56):
Yes or no? Right? And then you know, educate.
Speaker 2 (37:59):
Yourself early, be reactive to it, be proactive actually and then,
of course, lifestyle interventions. We know that lifestyle interventions in
terms of stress management, nutrition support, supplement, targeted supplement support,
and exercise can help with brain health. Interestingly, when we
move skeleton muscle, we release a hormone called a risin.
Speaker 3 (38:17):
Actually, so when we just move.
Speaker 1 (38:18):
Skeletal muscles, I don't even know, so.
Speaker 3 (38:21):
It's a myokine. Of course, it's a myokine.
Speaker 2 (38:23):
So it's a substance that's produced by the muscle that
when you just move muscle, it's a substance, a chemical substance.
It travels throughout the body into the brain and increases
your brain function and structure.
Speaker 1 (38:34):
Actually, I did my pilates today. Why did I move some.
Speaker 3 (38:37):
Yeah, that's piloates.
Speaker 2 (38:39):
Great, Just moving skeleton muscle will help your brain. And
we're getting the scientific so to provide context to it.
We can always tell people like what to do, but
why to do it? Actually will help people.
Speaker 1 (38:51):
I like that. I like that. I mean, we're reasoning.
My trainer did not tell me about that, but I'm
going to tell her about it because there is a
a reason for doing the six thirty am pilates. As
an oncologist, do you have any insight into why we're
seeing a rise in cancer in younger people.
Speaker 2 (39:10):
Why, you know, I don't think we understand that now.
I mean obvious targets are nutrition, social stressures, social structure
leading to increased stress, nutrition, environmental exposures. A lot of
people will point to nutrition right now, but I have
a lot of patients in my practice who practice excellent
nutrition who have had early young colon cancers and are
(39:32):
not a lot.
Speaker 1 (39:32):
But a few. Why is it something else in our food,
in our environment, in our water.
Speaker 2 (39:38):
Well, we also have to look to our microbiome. Is
our microbiome putting us at risk? Which is intimately linked?
So that's all The bugs that live in the gut
are really important, you know, is our microbiome at risk
from our modern lifestyle. I don't think we have those
answers yet, but those are kind of the targets of
where people are looking right now.
Speaker 1 (39:54):
Good research going on.
Speaker 3 (39:55):
Definitely lots of good research going on.
Speaker 1 (39:58):
So now this is a new project for doctor Poynter.
She has recently left her beautiful gynecological practice in a
private office with lovely help. By the way, your your
ultrasound woman was so amazing, you would go to doctor
Poynter's office and you would lie down on the table
and you would have your all your organs ultrasounded right,
(40:21):
and it was I really liked that because it was
such a nice way to start an examination, knowing that
there was nothing to look for.
Speaker 3 (40:28):
Empowering, right, It's very empowering.
Speaker 1 (40:31):
And doctor Poynter has left to join Atria. It's a
it's an organization started here in New York City. So
describe Atria.
Speaker 2 (40:39):
So Atria is super unique and poise to I think
make some really big contributions. Leaving my practice was like
literally ripping my heart out of my chest voluntarily.
Speaker 1 (40:48):
It was such a personal practice and your offices were
so personal. It was a unique place.
Speaker 2 (40:55):
Thank you for the compliments of the office. So Atria
is a multi specialty group. So I work next to
the smartest brain health people, the smartest endocrinologist, the smartest cardiologist.
We have nutrition experts, we have exercise experts. We even
have a naturopathic physician who has involved in integrative care.
(41:18):
We all work together and it's a real cross fertilization
of ideas and how to approach clinical issues, further research,
and also we are involved in patient care, and it
is the way that the world of what we call
primary prevention is going to move forward.
Speaker 3 (41:35):
It is a private organization, so.
Speaker 2 (41:37):
It's not bound by many of the constraints that will
happen in an academic setting. However, every physician who is
there has a very strong academic and research background. We
have strategy specialists all working together to help formulate and
develop a new model for how to deliver care and
(41:58):
how to deliver primary prevention because we want to be proactive,
we want to be predictive. We want to get things
before disease happens and before disease transitions, or pick it
up at its earliest point.
Speaker 1 (42:09):
How does one find out about ATRIA?
Speaker 2 (42:12):
So we're online of course, and a R I A.
We have two locations currently New York and Florida. I
have to pinch myself a little bit that I'm there
because I work with the smart, very smart people, the
smartest people I've worked with, and it was a lot
of the work that I was trying to do on
my own in my private practice, and I realize that
(42:32):
I can't do it all by myself, and I need
help to further the cause. Right, And so we're all
working together to further the cause of primary prevention medicine.
I think you'll see more in the future. Atre is
just getting started. It is just in its infancy, and
we are still in it two or.
Speaker 1 (42:48):
Three years old. It sounds like such a good way
to learn about oneself and know about oneself for the future.
I mean, you know, at my age, I really need
to know a lot.
Speaker 2 (43:00):
Right, and I think we're we're collecting the information on
how to get that to everybody in the future. And
how what do we need to know, how do we
need to know?
Speaker 3 (43:10):
How do we intervene?
Speaker 2 (43:12):
And this can only happen with a multi specialty group
that is nimble and can ask questions quickly and adjust
and readjust as needed.
Speaker 1 (43:21):
I got very interested in blood in the last five years,
so I will have a blood tist of complete you
call it what do you call it? Big?
Speaker 3 (43:29):
You say chemistry profile?
Speaker 1 (43:31):
And I get a choice a year and I look
at it and it's so funny how some things go
up and some things go down. Accounts go down. Is
that because the testing is different or is it because
the laboratory is different?
Speaker 3 (43:45):
OK?
Speaker 1 (43:46):
I'm not an expert in any way, but I just
like to see that I'm pretty stable and within the
parameters of good.
Speaker 2 (43:51):
Health, there's variability. There's variability in the human body. We
react to our environment, right. Our body is constantly reacting, readjusting, right,
So if you.
Speaker 1 (44:01):
Take an iron supplement, it's going to change your iron
and your blood.
Speaker 2 (44:05):
Correct and it's the human body is dynamic, so you know,
and you have to look at trends over time. We
look at trends over time. We look at not just
individual components of the blood, but how they're interacting together.
Speaker 3 (44:15):
And this our AI is really going to help us
in exciting.
Speaker 1 (44:17):
Wages to see that. Yeah, yeah, well, this is so fascinating.
Your practice has expanded exponentially with this new adventure that
you've joined. Very interesting to learn more about the challenges
facing women in each of their decades. We have to
pay be very aware of women listening about this, and
so to men. It's a very interesting time in medicine,
(44:40):
and I applaud your efforts. It's really great and I
look forward to your book.
Speaker 2 (44:44):
Thank you so much for having me and allowing me
to speak today. I think we're at a great time in medicine.
We're about to crack through some issues.
Speaker 1 (44:50):
Well, that is excellent to know. Thank you, doctor Pointer.
Earlier this season, I spoke with several experts about cosmetic
dermatology and the science of skincare. The response was terrific
and thank you very much. Today we're going to continue
to explore medical topics, discussing the latest research, innovations and
health recommendations. Today I am at Newsstand Studios right in
(00:24):
Rockefeller Center speaking with doctor Elizabeth Poynter, a gynecologic oncologist,
an advanced pelvic surgeon, and an expert in midlife women's health.
I've known doctor Poynter for several years and I am
so impressed by her depth of knowledge about women's health.
And just to clarify the situation, she has also been
(00:46):
my gynecologist for several years and I have been extremely
happy with her treatment and with her consultations. So many
are very hesitant to talk about menopause. Many doctors, many
women are hesitanted to talk about a very natural occurrence
in every woman's life. But I firmly believe it's important
(01:07):
to learn as much as possible and to understand how
the changes associated with menopause can affect physical, emotional, mental,
and social well being. Doctor Pointer, welcome to our podcast.
Speaker 2 (01:19):
Thank you so much for having me today and allowing
me to talk about to speak with you about.
Speaker 3 (01:23):
One of my favorite subjects, women's health.
Speaker 1 (01:25):
Well, it's so much more than about women's ability to reproduce. Elizabeth,
I've heard you say that we need to go beyond
bikini medicine. Can you tell me what you mean by that?
Speaker 2 (01:37):
So women have distinct physiologies from men, largely dictated by
fluctuating hormone levels throughout the month and throughout our lifespans.
So we know, and we've known for quite some time
that women are not small men. However, there hasn't been
a lot of work devoted to this or a lot
of research relating to this, And now we're just at
a pivotal moment where we're beginning to realize the importance
(01:58):
of specific female physiology and it needs to be studied
and entreated and looked at very differently through a different lens,
a hormonal lens.
Speaker 1 (02:06):
And you, as an expert, know a lot more than
most of us, because for the record, I've been on
hormone replacement since I was like forty years old. That's great,
and you want to know something, I think it is great.
I think it has kept me more vital, more healthy,
more my bones stronger. If that's true, I'm not sure
(02:27):
if that's just genetics or if it really has been
helped by my hormone replacement.
Speaker 2 (02:32):
Definitely for women, when hormone replacement, usually consisting of estrogen
or estrogen plus progesterone, started within a few years of
menopause or in that perimenopausal transition or before the age
of sixty, you're really going to get great benefits from it.
You're going to get cardiac benefits, cardiac protection, bone health protection,
of course, maybe even brain protection.
Speaker 1 (02:51):
That data I certainly hope. Yes.
Speaker 2 (02:54):
So it's great that you started early and had physicians
who were engaged and who actually did that foil years.
Speaker 1 (03:00):
It was because I had a lower abdominal hysterectomy after
the birth of my daughter, I developed fibroids or something
like that. I don't know, I can't you know. That
was a long time ago, and the doctor said, oh,
it'd be best if you just had this procedure and
then but he started me immediately on hormone replacement. It
was primarily progesterone and a little bit of justeosterone. I think, so.
Speaker 2 (03:24):
Before the Women's Health Initiative study that was very standard.
Kind of the advantage of being an older physician is
you get to see the history of medicine and the
history of trajectories and how we treat people. And when
I first started in surgical oncology, when we would remove
ovary's or do a hysterectomy with ovaries, we would always
recommend hormone support to protect the heart. The Women's Health
Initiative Study was published and came out in two thousand
(03:46):
and two and really took that off the table for
a lot of people, and a lot of doctors then
became very scared to provide hormone support for their patients
before well the study was the interpretations of the study
were prematurely released, right.
Speaker 3 (04:00):
We looked at the Women's.
Speaker 2 (04:01):
Health Initiative Study included one hundred and fifty thousand women
who were as young as in their forties and as
old as seventy nine, and they were randomized to either
be on hormone support or no hormone support. And what
we found is the risk of cardiac disease and breast
cancer was higher. But remember we were starting women far
after the transition of menopause. These were women who were
in their sixties and seventies, who were more than twenty
(04:23):
years for some of them probably after menopause. But when
we did a subset analysis, meaning we took and we
looked at specific populations or groups of women within that study,
we found that if hormones were started early in that
perimenopausal or menopausal transition, that you actually did gain significant
cardiac benefit from paramant support and decreased our death from
all causes actually other than breast cancer, which was slightly
(04:45):
elevated in this study.
Speaker 1 (04:47):
And not all surveys are the surveys that we need.
Speaker 2 (04:51):
We need to interpret studies the appropriate way just because
something is published and we need to look at how
to interpret it, and we have to be intelligent about
how we interpret it.
Speaker 1 (04:59):
Now I'm looking I had a very beautiful, slender, chic,
short skirted, long leggage, high heel wearing Guya colleges.
Speaker 3 (05:09):
Kay, I'm coming back here more often.
Speaker 1 (05:10):
When I first met doctor Porter, I thought she was
maybe the office assistant on a summer break from college
or but here here I am sitting next to a
very beautiful female doctor with long black hair. How do
you keep in shape like this with your horobably difficult schedule.
Speaker 2 (05:28):
Well, I practiced what I counsel my patients. I started
on hormones when I was forty three. I had some
new mood issues actually around the age of forty three,
and I was doing very large surgical oncology cases and
kind of hand ringing a little bit and developed some anxiety.
Speaker 1 (05:42):
Was your son born then?
Speaker 2 (05:43):
Note he was born. He was about a year or
two after he was born. And it was my mom
who said, oh, I think it might be your estrogen.
And so I actually started on hormone support due to
some anxiety, which was I'm now in retrospect, was definitely
the perimenopausal transition. And this is before anybody really reconnized
that anxiety or depression was actually linked to perimenopause or
(06:04):
menopausal transitions. So I started early on hormone support, and
I think it's kept my metabolism good. And I practice
what I speak about in terms of nutrition, exercise, lifestyle,
healthy sleep, good outlook, all those things that helped to
keep us young. So I try my hardest.
Speaker 1 (06:20):
There are men who will say, oh, she's in a
bad mood today, she's in menopause. Probably men are telling
me this and I mean, what do they know about menopause?
Speaker 2 (06:30):
Well, we need to educate them more. And I think
you're aware. My husband is a breast surgeon, and so
when I was starting on hormones, my husband is very
knowledgeable obviously about breast cancers. Like, no wife of mine
is going to start on hormones because of the breast
cancer risk.
Speaker 3 (06:44):
And we can talk more about that, and I hope
we do.
Speaker 2 (06:46):
But he went to all the best medical schools, had
all the best training, knew nothing about menopause, knew nothing
about hormonal transitions, and was like, this.
Speaker 3 (06:54):
Is no joke.
Speaker 2 (06:54):
And I'm like, yeah, no, it's not a joke in
terms of the changes that we go through. But I
think there's more conversation now. There's more out on social
media about menopause. There's certainly more in the popular press
about menopause, and so now individuals are men and women
are realizing that anxiety or depression or mood issues are
tightly linked to hormonal fluctuations.
Speaker 1 (07:14):
Now once on hormones, now I've been on hormones for
a long time. I started like right in my early
forties too. Does your treatment have to change? How do
you test for hormonal balance and everything.
Speaker 2 (07:27):
So this is the tricky part about hormonal management. Naturally,
we will need to change hormone dosing over an individual's lifetime.
If you still have your ovaries and you're transitioning through
perimenopause or into menopause, the ovaries don't just decide one
day they're going to turn off. They naturally decline, and
so we may start on lower doses of estrogen, we
may start on doses of progesterone with odd estrogen or
and then naturally anticipate that they will need to be
(07:49):
escalated over a woman's lifetime and then maybe drop down
a little bit when we get a little bit older. Actually,
so that this is a conversation and dialogue that every
woman should have with her physician or the person who's
helping her manage her hormones, because it's really a communication
because what works for one person doesn't work for everybody.
So it's very highly personalized medicine.
Speaker 1 (08:10):
I don't usually talk to people about their treatments or
medical treatments, but a couple of my very close friends
have spoken to me like, oh, why do you have
such a nice skin? And I say, I think it's
because of the hormones I taken, and of course genes,
but and I said, do you take hormones? And most
of them, most of my friends, have never been on
(08:31):
hormone replacement.
Speaker 2 (08:32):
So about that period of the Women's Health Initiative Study
when it came out, and I remember this, I mean,
we sent letters to our patients. At the time, I
was at Slung Cattering as a surgeon, and we sent
letters to our patients, you know, stop your hormones immediately.
We were very couscormed about it. Stop them immediately. Well,
about fifty percent of people went back on hormone support. Actually,
so fifty percent has significant symptoms off of hormone support.
(08:55):
So everything with the Women's Health Initiative Study came from
a screeching halt because it was just a knee jerk
reaction because there was an elevated relative risk of breast
cancer with this type of hormone support that was prescribed
in this study, everybody to stop their hormones. And instead
of throwing out the drugs and saying, okay, these drugs
might not be the safest that we could use, we
(09:16):
actually throughout the issue. We threw out menopause and said, well,
there's nothing we can do for you because this Women's
Health Initiative study came out. You can't take hormones, they're
not safe. But we have newer preparations now that the
French have had for a number of years, longer than us,
that are actually safer than our older preparations, and this
is now being brought to the forefront, so we have
instead of saying we can't do anything, we now have
(09:37):
safer preparations to treat with well.
Speaker 1 (09:39):
Most discussions around hormone therapy is about relieving symptoms of menopause,
but they must affect so many other parts of our health.
I mean, they must help so much more in bone
strength and good hair.
Speaker 3 (09:53):
Is that true? Absolutely?
Speaker 2 (09:54):
There's estrogen receptors all throughout the body. I mean we
could talk from the tip of your head down to
your toes, to the muscle, bones and joints basically. So
there's estrogen receptors in the brain that are increasingly being
identified as being important actually and maintaining cognitive function for women.
Speaker 3 (10:10):
In terms of estrogen support.
Speaker 2 (10:12):
It was recently published that around the time of perimenopause,
estrogen receptors are those hearts of our cells that hold
on to estrogen actually increase at the time of perimenopause,
and there's some data out that really suggests that women
who are on early hormone support within three years of
menopause actually have improved cognitive function and may have a
decreased risk of dementia. Overall, that's the brain, cardiac health.
(10:34):
We know that there's a thirty percent reduction in all
cause of mortality other than breast cancer with hormone support,
and that's thought to be largely through cardiac risk. Skin
definitely increases, collagen production, decreases fine lines and wrinkles. There's
data in the literature that few people review and discuss
that even with topical estrogen we can improve skin muscles. Well,
(10:54):
of course we are muscle mass changes when our estrogen drops.
It can also drop and decline as estra levels decline.
Bone health has been recognized for many years that as
estrogen declines, bone health deteriorates, and we can help bone
health by adding back estrogen. So really and metabolism also, right,
So when estrogen levels start to decline, we begin to
develop metabolic disruptions. So you can look at every organ
(11:17):
system in the body basically and have some link to
hormone fluctuations in terms of the health of that organ system.
Speaker 1 (11:23):
So what happens to the woman who has a brisk
cancer history in the family, what do you tell her
about taking hormones.
Speaker 2 (11:30):
So a family history of breast cancer without a personal
history of breast cancer is not an absolute contra indication
to hormones. Even with our highest risk individuals in terms
of genetic mutations, we will many times speak with them
about hormone support after ovaries are removed and recommended. Actually,
so I think every individual in every situation is to
be personalized, but a family history of breast cancer is
(11:52):
not a contraindication to hormone support.
Speaker 1 (11:54):
Are you writing about this too?
Speaker 2 (11:56):
Oh yeah, oh yes, yes, So we're working in a book. Definitely,
we're writing about this.
Speaker 1 (12:01):
When is that book available, Probably.
Speaker 2 (12:03):
Within the next eight or nine months. We want to
offer you solutions and how you can age beautifully and
be vibrant just as you're doing.
Speaker 1 (12:11):
I have so many friends who need this book, so
good luck with it. I can't wait. I can't wait.
Thank you. You'll have to come back on the podcast
to talk about the book. So what innovations are you
seeing about when it comes to the science of managing
(12:33):
and treating the symptoms of MENOPAUSEA when do you know
that you're in menopause? When? How do you know?
Speaker 2 (12:39):
So menopause is really defined as being postmenopausal as you
don't have I haven't had a period for a year.
But that's an antiquated kind of definition, right, because that
definition was before we had laboratory testing. Everybody kind of
forgets you know, one hundred years ago we weren't able
to check for these levels of bollicle stimulating hormones and
asterrodial level. So menopausemeaus you haven't had a period. And
when your post menoposamis you haven't had a peer in
(13:00):
one year. Perimenopause is that time leading up to menopause.
And then perimenopause really can start anywhere between eight and
ten years prior to your final menstrual period.
Speaker 1 (13:11):
So women, that's an elongated right in a bad mood? Well,
I mean that's what you hear. Everybody is in a
bad mood.
Speaker 2 (13:19):
Think everybody reacts differently, right, I mean, I think everybody
has their own different types of issues as their hormone
levels fluctuate. And that's actually an interesting question is in itself.
Why are some individual symptomatic and others not right?
Speaker 1 (13:30):
And could that be also because if they were taking
hormones maybe that would prolong good health or of course,
and that's when I phone the actual menopause.
Speaker 2 (13:39):
Right, that is one of the big questions that I
have actually just as a practitioner. If we start hormones earlier,
can we stave off some of these cognitive changes that
we see because right at the time of perimenopause and menopause,
we see real changes in the brain. The brain size changes,
the blood flow changes, the metabolism change them. You can
see it on scans. So if we start hormones earlier,
especially at women who maybe elevated risk of cognitive issues
(14:02):
and that type of thing, if we start earlier before
fluctuations really set in, can we actually stave off these
issues even better? And those are big questions right now
that are not just now being asked and beginning to
be answered based at a basic science level and at
a clinical level also.
Speaker 1 (14:16):
So are you giving brain scans to women now on
a regular basis?
Speaker 2 (14:21):
There are research protocols where people are beginning to do that,
looking at MRIs of the brains, looking at brain size,
brain processing, this type of thing, and that's very kind
of elevated testing.
Speaker 1 (14:32):
What about physical tests physical.
Speaker 2 (14:34):
Test Well, certainly in terms of cognitive testing, there are
definitely physical testing. But by the time you have manifested
any of these physical symptoms, and I'm just talking about
brain health as an example, we could talk about every
organ system. But the time you've manifested, you are transitioned
into a disease state. So we want to keep you
from transitioning into a disease state. We want to cut
we want to prevent anything.
Speaker 1 (14:54):
Early detection, early examination is best.
Speaker 3 (14:57):
Yeah, and early prevention.
Speaker 1 (14:58):
So like what age would you say a woman and
should start really considering this?
Speaker 2 (15:02):
So I think you know, women between the ages of
thirty five and forty can begin to see significant hormonal
fluctuations and really need to pay attention to their symptoms.
Right now, we don't have great laboratory testing. Again, this
is an area that I'm super interested in, is can
we really begin to define when estrogen levels start to
fluctuate or progesterone levels start to decline with our current
testing that's really well accepted. We're not really there yet,
(15:24):
and we have to listen to narratives, And this is
why doctors need and physicians and healthcare providers really need
to listen to the patients that they're caring for about.
You know, may have a little more anxiety, like some
of the earliest symptoms of actually hormone changes, a little
bit of anxiety, maybe a little shape shifting. You don't
even have to gain weight, you just get a little
thicker in the waste. That may represent an accumulation of
(15:44):
what we call visceral fat, which happens as estrogen levels
start to decline. May have a little new anxiety, libido
issues actually or early worn early symptoms of estrogen fluctuations,
vaginal dryness at certain time points of the month, actually
a cycle maybe, So we need to listen to our
narratives of our patients to really kind of determine where
they are in this transition. And then it'd be great
(16:07):
to have some laboratory testing too.
Speaker 1 (16:09):
And women should be a little bit more open with
their doctors. I would say, are women are still a
little shy? I think sometimes I think so physical being.
Speaker 3 (16:18):
I think some that's changing.
Speaker 2 (16:19):
I think thanks to social media and the internet and
more conversations. You know, I realized during COVID actually that
when we were having these kind of anonymized zoom meetings
and things like this with patients and speaking groups, that
women talked a little bit more freely. And now they
can get information a little bit more easily, so they
might become a little bit more open. And this generation
of women now who are transitioning through menopause are very
(16:41):
open about it. And that's great because that's bringing all
of this conversation to the forefront and helping women to
open up about it. But still you still have to
elicit and ask questions, do you have pain with intercourse?
Do you have vaginal dryness? People don't always volunteer that information.
We have specific questions that we ask our patients.
Speaker 1 (16:58):
So it's up to the doctors as well as the
patient's Absolutely we have overt and uh open about all this.
There's so many other questions to ask a guidecologist of
your stature. What is the current guidance on frequency of mamograms?
Speaker 2 (17:12):
For example, most professional societies actually recommend a yearly mammogram.
Still AI is going to help that, I hope actually
in terms of in terms of looking for pattern recognition,
I mean, AI is like so great looking at pattern recognition, Like,
we're at a point now where we can look at
an EKG and this was just brought to my attention,
and that AI group can look and that the machine
learning can look and say it's a male or female EKG.
(17:34):
There's no physician who can do that. So now we
have all this great pattern recognition. So this is really
going to contribute to our screening. But most people still
recommend a yearly mammogram and of course a breast ultrasound
if you have dense breast and if you're at elevated risk,
consider a breast MRI.
Speaker 1 (17:48):
And what about pap smears.
Speaker 2 (17:50):
Pap smear is a little bit less on the guidance
in terms of the frequency is recommended now every two
to three years if you haven't had an abnormal pap
smere or HPV negative testing every five years if you're
over the age of thirty and HPV negatives.
Speaker 1 (18:03):
So I used to be every visit right.
Speaker 2 (18:06):
But there's guidelines are for population health, right, and so
it's always like I always, I think it's a conversation
between the individual and the person who's taking care of them.
Speaker 1 (18:16):
Of course, copies seems like everybody is prepping for a kolonoscopy.
Speaker 3 (18:22):
Well, so colonoscopy.
Speaker 2 (18:23):
We've decreased the age of recommendation of kolonoscopy down to
forty five. That's because we're seeing aggressive colon cancers and
younger people. We're not quite sure why, but definitely colonoscopy
has remained the gold standard. But there's also there's liquid
tumor biopsies looking for fragments of tumor DNA in stool
samples and such, and also in the blood. And so
(18:43):
these screening modalities are also poised to contribute.
Speaker 1 (18:47):
To mail order stool samplings. That right, I mean you
could just you can just put some poop in a
in a tube and send it off in the mail.
Speaker 3 (18:55):
Right.
Speaker 1 (18:55):
Are those accurate?
Speaker 3 (18:56):
They are very accurate.
Speaker 2 (18:58):
They are not well accepted for an individual who is
known to be at elevated risk, such as.
Speaker 3 (19:03):
A family history or a pre do that, you know,
they're extremely accurate.
Speaker 1 (19:09):
They're a little scary to me.
Speaker 2 (19:11):
The easier that we can make a screening test for
somebody and the less invasive that it will be, the
more acceptable that it will be. Overall, and so, and
I think again we're moving as we get as we
have more molecular diagnostics.
Speaker 1 (19:24):
And I always worry about the temperature, and if it's
one hundred degrees outside, well, any symptoms disappear, you know,
That's what I think about if it's in the mail.
For us, ever, are sitting in a hot truck for
four days, right.
Speaker 2 (19:34):
We're looking at fragments of DNA and such, and so
that's pretty stable.
Speaker 1 (19:38):
Actually that's stable. Yay? Stable? So can you break down
by decade? This is a this is a kind of
a hard question. How should women adjust their medical routines
and health habits. Let's just say in their late thirties forties.
What do you do then?
Speaker 2 (19:53):
So, for for many women in their late thirties, they're
completing child bearing if they've chosen to have children, and
are focused less on reproduction and more on now focusing
attention a little bit to their own health. And some
of us need attention, need to do that, and because
we all have busy lives or we're taking care of children,
or we're taking care of our families, or we're working.
(20:14):
But this is a time after child bearing, right to
really begin to focus and focus on health. And that
is healthy exercise, making sure that you move every day,
healthy nutrition, staying socially engaged, stress management, paying attention to
sleep for a lot of people, which is also very difficult.
But you know, late thirties early forties time to just
(20:35):
establish your patterns and patterns of good health and also
listen to your body. What's your body telling you? You know,
we don't talk as physicians about this enough. Like your
body will speak with to you a little bit. Sometimes
it whispers, but it'll tell you when things are a
little bit of wry or not wrong. So I always
try to tell women, you know, if you feel like
something's not right, bring it to the attention of your physician.
So thirties and forties are where you're started to listen
(20:56):
to your body and establish good health habits and get
into the to the routine of making sure that you
get a yearly exam. See you see your physician once
a year, have your lipids checked, have your hemoglobin A
one seed checked, find out what your baseline is and
where you're starting from, and then grab onto some good
health habits to age with strong and what you do.
(21:16):
So fifties are a time where really estrogen levels are
really declining, and so thirty five to forty to to
the late forties, right, we're starting to we see estrogen fluctuations,
but we really see estrogen levels start to decline in
the early to mid fifties. And so again that's paying
really close attention to your symptoms. Knowing your family history,
know your family history of cardiac disease, know your family
(21:36):
history of dementia, speak to your health care provider's hormone
support right for you. Paying attention to maybe not feeling yourself.
I always as my patients, you know, do you have
you lost your JOI de v You know, you might
say I'm not, I don't have anxietyor depression.
Speaker 3 (21:49):
But you might say, you know, I don't feel like myself.
I don't.
Speaker 2 (21:52):
I don't have the same confidence when you while I
walk into the boardroom, Am I having any word finding difficulty?
It's really about how am I enjoying my life?
Speaker 3 (22:00):
You know?
Speaker 2 (22:00):
These are all just very subtle things that we as
physicians don't always ask, but these are important things to
ask yourself. And then if you have any of these
issues and they're new for you, something that's new or
different from you needs to be addressed. Actually, sixties sixties
that's a time to really double down. I think on nutrition, exercise, mindset,
stained socially engaged, making sure you have a great sense
(22:22):
of purpose.
Speaker 3 (22:23):
Of course, having all of your testing that.
Speaker 2 (22:25):
You would normally have with blood test, I failed to
mention a coordinary calcium score. But know your family history
of cardiac disease super important. But consider advanced testing in
terms of more advanced cardiac testing in the fifties and
early sixties, pay attention to that, of course. Also the
sixties are where we have to, I think, make a
real concerted effort, Like I am going to exercise every day.
I'm going to do one hundred and fifty minutes of
zone two cardiac. I'm going to do strength training three
(22:47):
days a week. I'm going to make sure that I'm
eating enough protein because we tend to lose muscle masses
we age, so we want to make sure we ramp
up the protein, decrease the carbohydrates. Maybe a little bit
in nutrition a little controversial with that, yeah, but definitely
ramp up the proteins. And how you adjust that with
your carbohydrates, that's your choice, but.
Speaker 3 (23:06):
Definitely ramp up on protein.
Speaker 2 (23:07):
And then I think it's really like I said, sleep
is really important, becomes a little bit more difficult to
sleep as we age, and so what.
Speaker 1 (23:13):
Should one do about that? I mean, this is so
many people are talking about, Oh I can't really sleep.
I can't.
Speaker 2 (23:18):
One thing that's really important is realize that sleep is
an active process. Realize that it's something that's really important.
It's not like you just go to sleep and your
body's not doing stuff. It's doing really important stuff, right,
So scheduling sleep, making sure and we all know sleep hygiene,
you know, turning screens off, giving yourself an hour of
wind down, you know these things. But also I think
it's really important just to get in that mindset of
(23:39):
training your body to realize that sleep is important. And
also I just recently got an aura ring. You're supposed
to wearing a four PingER. I get data on my
ring finger. But what that showed me which was really interesting.
I mean I have a million degrees from all these
Ivy League educations, and I didn't realize that being in
bed does not mean that you are asleep, that you
are sleeping exactly, or a ring gives you or any
(24:01):
of these wearables whoop or any of these give you
insight into if your sleep is disrupted.
Speaker 1 (24:06):
Or by the way is, Oh, you are a and
I just got one. It was too small for me.
So I'm waiting for my new one to come because
i want to wear it on my forefinger. It is,
and I want to I'm dying to see what my
horrible sleep habits.
Speaker 2 (24:21):
It will give you a lot of insight and then
you can see, like, you know, does a little bit
of wine the night before does it disrupt my sleep?
And you'll be amazed that like two ounces of wine
will actually lead to some sleep disruption or you know,
I'm always amazed at the heart rate variability actually correlates
with my stress.
Speaker 3 (24:39):
Actually, it's really so. It gives you good insight into
when you sleep better? What did I do the day before?
Speaker 1 (24:46):
What to do correct exactly? That's what I'm looking forward
to to really determining with mine. So what should we
do in our seventies.
Speaker 2 (24:54):
I think similar to the sixties. I mean, you just
you really want to make sure that you are really
focusing non nutrition, exercise, sleep. I think even more so
sense of purpose and social engagement becomes really important in
the seventies. I think that we need to you know,
we live in I always say it's a great time
to get being getting older in our society right now,
(25:16):
because I love all the older Instagram accounts, I love
the older the magazines that are for individuals post fifty.
I think it's really great. In the past, we wouldn't
have seen these.
Speaker 1 (25:25):
Public AA and what else.
Speaker 2 (25:27):
Yeah, oh, there's there's a few others actually that don't
have retired in the.
Speaker 1 (25:30):
Title because AARP is like that retired shouldn't be there,
because yeah, I encourage people never to retire.
Speaker 3 (25:37):
I'm not retiring. No, yeah, don't Yeah, I'm not retired never.
Speaker 2 (25:40):
But I think that's why that sense of engagement and
purpose becomes really important, because a lot of us will
exit the working fields, and I think that we have
to really focus on community, sense of engagement, sense of purpose.
These are all if you look at the common denominators
of individuals are centurions, and they are people who have
a great sense of purpose, a great sense of optimism.
(26:01):
They remain socially engaged. So got to do all the
other good stuff with nutrition exercise. Protein exercise becomes even
more important because you want to really maintain muscle mass
and don't want to become frail, and because that has
its own set of issues. But that maintaining of that
social structure is so important and sense of purpose is
so important, and then eighties, same thing, really the same thing,
(26:23):
and I think, you know, just really maintaining that all
those great health abb is that you established.
Speaker 1 (26:29):
It's harder and harder to find doctors to take care
of you as you get older. Being involved with the
Center for Living at Mount Sinai, I learned that geriatric
medicine is a medicine that for a while fill out
of favor because doctors didn't want to deal with elderly people.
But now with the aging population, it's starting to become
(26:50):
a more interesting field of endeavor for doctors. So I
hope more and more go into geriatric medicine because we
need to really deal with all of those as we
get older and not feel bad about getting older.
Speaker 2 (27:03):
It's great to get older. You want to age strong.
You want to be you want to age with strength.
That's the title age strong. You want to be strong
as we because you're getting older. The opposite is no good, right.
You want to get older. You want to be chronologically
older and biologically fit and a little bit younger. And
I think that this is a great time. I'll always
say it. I think we're aging with more optimism now,
(27:24):
and I think we're on the cusp of really changing
that whole approach to medicine for older individuals.
Speaker 1 (27:31):
When it comes to longevity medicine. Are there specific considerations
for women that would be different from men.
Speaker 2 (27:38):
Totally in terms of longevity. You know, we're just now
realizing the importance of estrogen to basic issues such as dementia,
cardiac disease, and cancer. Right, these are the three things,
the three issues they associated with aging. Mitochondrial support and
inflammation are issues as we age, right, or mitochondria aren't
as strong. Those are the little powerhouses that make energy
(27:58):
in ourselves, and we have more inflam so we really
need to pay attention to ways to mitigate that.
Speaker 1 (28:02):
Well, how do you because inflammation, I think is a
big problem. I feel it.
Speaker 2 (28:07):
Yeah, that is a strong foundation in nutrition, exercise, good mindset,
keeping your cortisol levels lower, so managing stress super important.
Speaker 3 (28:16):
And then I'm going to say.
Speaker 2 (28:17):
It estrogen, right, because estrogen is an anti inflammatory, it's
an antioxidant, so that will definitely help. There's some evidence
that actually estrogen directly impacts on the mitochondria. So what's
new in longevity medicine is that we're we.
Speaker 1 (28:30):
Are remembering that word everyone medachondria.
Speaker 3 (28:33):
Yeah, that's really important.
Speaker 2 (28:35):
They're what we're realizing is that women and men are
different and and that will translate over at the cellular
level also in terms of how we respond.
Speaker 1 (28:43):
Tot Oh, of course, that's what I want to know.
Speaker 2 (28:50):
I think, you know, women, so women live tend to
live longer than men, but we live currently we still
live in more years of being unhealthy. We have fewer
years of active health than men.
Speaker 1 (29:01):
Do.
Speaker 2 (29:01):
We really have to get to the bottom of that
and why that occurs. And that's you know, because we
didn't have women in research until nineteen ninety three and
I AGE did it and mandate at female animals until
twenty sixteen. So we live more years in poorer health
than men, but we tend to live longer. But the
idea is to get us to get to better health.
Actually for those all of those years.
Speaker 1 (29:30):
Let's get real about midlife metabolism and women. What happens
to our metabolism as we age?
Speaker 2 (29:36):
So as estrogen levels go down, we do this shape shifting, right,
so we begin to deposit fat in the visceral areas
or the abdominal areas, so around your liver, around your heart,
and your stomach. Basically, so the fat are adipocites that
live in the hip region and buttock region actually begin
to not migrate, but shifts into to the visceral area.
(29:59):
That becomes an flammatory and then that leads to what
we call insulin resistance, so we have metabolic disruption, so
and that also leads to more inflammation. So it becomes
a vicious cycle of low estrogen levels, visceral fat deposition, inflammation,
more visceral fat deposition.
Speaker 1 (30:14):
Meno pot.
Speaker 2 (30:16):
I wouldn't use that term because I am a professional,
but there is that term that is definitely circulating. Yeah,
I wouldn't use that, but that is definitely circulating around
and that does refer to our waste to hip circumference
ratio increases, and that's actually a better measure of what's
going on in our body because one term that we
do use is called skinny fat.
Speaker 3 (30:36):
You can be abnormal weight.
Speaker 2 (30:38):
Or of normal BMI, but all of that fat can
be in your abdominal area and that's unhealthy and that
leads to this what's called insulin resistance and weight gain.
Speaker 1 (30:48):
And eat of watermelon a day. I just read that's
a new hack. Just eat a watermelon a day and
you will not ever get fat in your stomach. Well,
that just came over the you know, that was on
the Instagram the other day.
Speaker 2 (31:03):
But that reminds me of the old pineapple diet for
the nineteen seventies, of which I ate so much pineapple
that my mouth was about to fall off. So yeah,
I don't think eating a watermelon a day.
Speaker 1 (31:11):
I don't either. But sleep habits are of ultimate importance.
Speaker 2 (31:17):
Sleep is really important. Sleep is really important to cognitive function.
Less sleep equals worse cognitive function, it equals higher when
people who don't sleep have a higher risk of dementia.
It is, like I said, it is an active process.
We're clearing our brain waste products. There's a whole system
where the way lymphatic fluid circulates around the body at night.
Speaker 1 (31:37):
So you think that when you're sleeping, all that is
going away.
Speaker 2 (31:40):
There is, there's active So it's an active process. It's
like it's an active process.
Speaker 1 (31:45):
It's not bunk, as my grandfather would say.
Speaker 2 (31:48):
No, And it's really really, really important. And I actually
did a course for a malpractice carrier recently, and it
was all about sleep and cognition and cognitive function. And
there's been a lot of studies and physicians that we
make poor diagnostic when we have less sleep, and it's
really so there is an activity that is going on
in our brain as we sleep.
Speaker 1 (32:07):
Is there a connection to cardiovascular health? How lipids and
cholesterols start to change at this age and beyond.
Speaker 2 (32:14):
Certainly in terms of there's a link to sleep in
cardiovascular health because when we don't sleep, where we live
in an inflame state, and that's actually bad for cardiac health.
And in terms of cardiac health and lipid metabolism are
extremely linked. And at midlife our lipids change in our
cardiac health changes.
Speaker 1 (32:29):
So what are some no nos in terms of diet
for anti inflammatory?
Speaker 3 (32:35):
Get rid of processed food.
Speaker 2 (32:36):
So anything that has more than three ingredients on it
is probably a processed food. Shop the periphery of the supermarkets.
Eat freshole food and don't use added sugars. Sugars are
super super inflammatory. The sugars that you get in fruits
and berries actually are fine because they come with fiber,
but the sugar that's just added into something is not
good at super inflammatory.
Speaker 1 (32:56):
So you don't eat any sugar.
Speaker 2 (32:57):
I really minimize it, really pay attention to that chocolate,
dark chocolate. Dark chocolate's great for your brain, good antioxidants.
So no, no sugar.
Speaker 1 (33:06):
Coffee.
Speaker 2 (33:08):
So there's one hundred studies trying to prove that coffee
is bad for you, but no studies have shown that
it's really bad for you. They tried to link it
to pancreatic cancer at one point that was not successful.
So I can't find anything bad about coffee, and coffee
has antioxidant's good for your brain.
Speaker 3 (33:21):
Especially teas are okay. Also same thing.
Speaker 2 (33:24):
You just have to watch out for your caffeine content,
especially with teas. Also, you just want to drink a
tea that's caffeinated too close to sleep because that can
really be a disruptor for your sleep.
Speaker 1 (33:34):
Diet coke, oh.
Speaker 3 (33:37):
So yeah, that would be a processed food.
Speaker 1 (33:39):
More than three ingredients. Those are the things that people forget.
They think that that's just water.
Speaker 2 (33:45):
Yeah, and you have to look at artificial sweeteners and
the impact that they have. A lot of physicians, especially surgeons,
have big diet coke habits. And I stopped diet coke
a while ago, and when I was actually stopping drinking it.
I actually had like some mood issues and I was like,
this is so weird. I'm like, everything's great. I shouldn't
have any mood issues. And then I start reading about
I was like, oh, I'm withdrawing from all the aspartame.
Speaker 1 (34:06):
When I read about artificial sweeteners or actually, my daughter
pointed it out to me. She had listened to an
interview with the man who invented an artificial sweeteners, the
most popular one, and he said that if he could
do it all over again, he would never invent it. It's
interesting because it's so dangerous for the human health. But
(34:27):
I don't use a lot of sugar, but I do
like dessert.
Speaker 2 (34:30):
So there's a ninety percent rule, right that we have
got to enjoy life, right, you know, just don't need
a lot of chocolate cake or eat a lot of
cake all the time.
Speaker 3 (34:37):
You know, but what do you use? It's nice to enjoy.
Speaker 1 (34:40):
Every now and then. So how do we deal with
mental health and mood and women's health.
Speaker 2 (34:48):
I think that we need to be really attuned to it.
And this is where as health providers and specialists in
women's health, we really need to key in on that
that so just can be a simple question about how
are you feeling? Are you feeling any different? How are
you feeling? That goes back to those JOI de v questions,
And I do think that we need more mental health
providers that are keyed into midlife women's health and really
(35:11):
understand these changes that occur because estrogen and progesterone really
do affect the neurotransmitters. I mean, there are real issues
that are medically happening in the brain as estrogen levels
are fluctuating. We see that also in women before midlife
with PMS and PMDD and postpartum depression, and the treatments
of these issues and recognition of these issues definitely warrant
(35:33):
further study and for their higher numbers of individuals involved
in these specialties.
Speaker 1 (35:37):
Is it true that women are at higher risk for dementia?
Speaker 3 (35:40):
Yes? Two thirds of Yes, totally.
Speaker 2 (35:42):
And this is one area that I'm super interested in
actually and is gaining in popularity in terms of interest,
And because why is that? Is it hormone fluctuations? Is
our lifestyle what makes us more susceptible intimasions? A lot
of individuals are looking at the role of hormones on
the female brain, and we are moving in that direction.
Lifestyle factors are also being looked at, but that research
(36:05):
is really accelerating and it's super exciting. And this leads
us back to, you know, can we identify women who
are at high risk and then get hormone support or
lifestyle support initiated earlier?
Speaker 1 (36:16):
Are there lifestylent interventions that one a woman can take?
Speaker 2 (36:20):
Absolutely anti inflammatory nutrition, making sure that you have your
homoicystine levels checked, which is inflammatory for the brain and
the heart.
Speaker 1 (36:28):
Good stress who does that? Who?
Speaker 3 (36:31):
Generalists can do that? Check? You can add what is
it's a blood test?
Speaker 2 (36:34):
There?
Speaker 3 (36:34):
These are blood tests and is what do you ask for?
Speaker 2 (36:37):
I would ask for just a general metabolic panel. I
would ask for homoicysteine levels and that's not all generalists
will do a homicistine level but super important, super and
I think that we are at elevated risk for dementia
and cognitive issues, so we need to be a little
bit more aggressive in our female population. But definitely early
identification of individuals who may be at elevated risk and
(36:59):
warrant more intensive interventions. And then for individuals who are
not deemed to be at risk. We are all at
risks because we're all women, you know, so, but just
paying attention close attention to lifestyle factors and those subtle
hormonal issues that you know. And one of the first
signs of perimenopause is like word finding difficulty. Sometimes I'll
ask people, you know, is your memory off, and they'll say, no,
(37:19):
it's not really often. So are you having any word
finding difficulty?
Speaker 1 (37:21):
Oh?
Speaker 2 (37:22):
Yeah, I can't remember names the same way. So what
we what we call associative memory or coordinating like like
things or faces and names and such starts to go
off a little bit and word finding goes off a
little bit, and that can be correlated actually with real
changes in the brain structure. So these are active areas
of research and are just.
Speaker 1 (37:41):
What can one do about that?
Speaker 2 (37:43):
Again, review it with your position. Maybe are your healthcare providers.
Speak to your provider about maybe starting on hormone support
earlier if you're considering it. And I think this is
one one thing that I'd recommend to people. Also kind
of get your opinion on hormon support. Are you going
to go in that direction?
Speaker 3 (37:56):
Yes or no? Right? And then you know, educate.
Speaker 2 (37:59):
Yourself early, be reactive to it, be proactive actually and then,
of course, lifestyle interventions. We know that lifestyle interventions in
terms of stress management, nutrition support, supplement, targeted supplement support,
and exercise can help with brain health. Interestingly, when we
move skeleton muscle, we release a hormone called a risin.
Speaker 3 (38:17):
Actually, so when we just move.
Speaker 1 (38:18):
Skeletal muscles, I don't even know, so.
Speaker 3 (38:21):
It's a myokine. Of course, it's a myokine.
Speaker 2 (38:23):
So it's a substance that's produced by the muscle that
when you just move muscle, it's a substance, a chemical substance.
It travels throughout the body into the brain and increases
your brain function and structure.
Speaker 1 (38:34):
Actually, I did my pilates today. Why did I move some.
Speaker 3 (38:37):
Yeah, that's piloates.
Speaker 2 (38:39):
Great, Just moving skeleton muscle will help your brain. And
we're getting the scientific so to provide context to it.
We can always tell people like what to do, but
why to do it? Actually will help people.
Speaker 1 (38:51):
I like that. I like that. I mean, we're reasoning.
My trainer did not tell me about that, but I'm
going to tell her about it because there is a
a reason for doing the six thirty am pilates. As
an oncologist, do you have any insight into why we're
seeing a rise in cancer in younger people.
Speaker 2 (39:10):
Why, you know, I don't think we understand that now.
I mean obvious targets are nutrition, social stressures, social structure
leading to increased stress, nutrition, environmental exposures. A lot of
people will point to nutrition right now, but I have
a lot of patients in my practice who practice excellent
nutrition who have had early young colon cancers and are
(39:32):
not a lot.
Speaker 1 (39:32):
But a few. Why is it something else in our food,
in our environment, in our water.
Speaker 2 (39:38):
Well, we also have to look to our microbiome. Is
our microbiome putting us at risk? Which is intimately linked?
So that's all The bugs that live in the gut
are really important, you know, is our microbiome at risk
from our modern lifestyle. I don't think we have those
answers yet, but those are kind of the targets of
where people are looking right now.
Speaker 1 (39:54):
Good research going on.
Speaker 3 (39:55):
Definitely lots of good research going on.
Speaker 1 (39:58):
So now this is a new project for doctor Poynter.
She has recently left her beautiful gynecological practice in a
private office with lovely help. By the way, your your
ultrasound woman was so amazing, you would go to doctor
Poynter's office and you would lie down on the table
and you would have your all your organs ultrasounded right,
(40:21):
and it was I really liked that because it was
such a nice way to start an examination, knowing that
there was nothing to look for.
Speaker 3 (40:28):
Empowering, right, It's very empowering.
Speaker 1 (40:31):
And doctor Poynter has left to join Atria. It's a
it's an organization started here in New York City. So
describe Atria.
Speaker 2 (40:39):
So Atria is super unique and poise to I think
make some really big contributions. Leaving my practice was like
literally ripping my heart out of my chest voluntarily.
Speaker 1 (40:48):
It was such a personal practice and your offices were
so personal. It was a unique place.
Speaker 2 (40:55):
Thank you for the compliments of the office. So Atria
is a multi specialty group. So I work next to
the smartest brain health people, the smartest endocrinologist, the smartest cardiologist.
We have nutrition experts, we have exercise experts. We even
have a naturopathic physician who has involved in integrative care.
(41:18):
We all work together and it's a real cross fertilization
of ideas and how to approach clinical issues, further research,
and also we are involved in patient care, and it
is the way that the world of what we call
primary prevention is going to move forward.
Speaker 3 (41:35):
It is a private organization, so.
Speaker 2 (41:37):
It's not bound by many of the constraints that will
happen in an academic setting. However, every physician who is
there has a very strong academic and research background. We
have strategy specialists all working together to help formulate and
develop a new model for how to deliver care and
(41:58):
how to deliver primary prevention because we want to be proactive,
we want to be predictive. We want to get things
before disease happens and before disease transitions, or pick it
up at its earliest point.
Speaker 1 (42:09):
How does one find out about ATRIA?
Speaker 2 (42:12):
So we're online of course, and a R I A.
We have two locations currently New York and Florida. I
have to pinch myself a little bit that I'm there
because I work with the smart, very smart people, the
smartest people I've worked with, and it was a lot
of the work that I was trying to do on
my own in my private practice, and I realize that
(42:32):
I can't do it all by myself, and I need
help to further the cause. Right, And so we're all
working together to further the cause of primary prevention medicine.
I think you'll see more in the future. Atre is
just getting started. It is just in its infancy, and
we are still in it two or.
Speaker 1 (42:48):
Three years old. It sounds like such a good way
to learn about oneself and know about oneself for the future.
I mean, you know, at my age, I really need
to know a lot.
Speaker 2 (43:00):
Right, and I think we're we're collecting the information on
how to get that to everybody in the future. And
how what do we need to know, how do we
need to know?
Speaker 3 (43:10):
How do we intervene?
Speaker 2 (43:12):
And this can only happen with a multi specialty group
that is nimble and can ask questions quickly and adjust
and readjust as needed.
Speaker 1 (43:21):
I got very interested in blood in the last five years,
so I will have a blood tist of complete you
call it what do you call it? Big?
Speaker 3 (43:29):
You say chemistry profile?
Speaker 1 (43:31):
And I get a choice a year and I look
at it and it's so funny how some things go
up and some things go down. Accounts go down. Is
that because the testing is different or is it because
the laboratory is different?
Speaker 3 (43:45):
OK?
Speaker 1 (43:46):
I'm not an expert in any way, but I just
like to see that I'm pretty stable and within the
parameters of good.
Speaker 2 (43:51):
Health, there's variability. There's variability in the human body. We
react to our environment, right. Our body is constantly reacting, readjusting, right,
So if you.
Speaker 1 (44:01):
Take an iron supplement, it's going to change your iron
and your blood.
Speaker 2 (44:05):
Correct and it's the human body is dynamic, so you know,
and you have to look at trends over time. We
look at trends over time. We look at not just
individual components of the blood, but how they're interacting together.
Speaker 3 (44:15):
And this our AI is really going to help us
in exciting.
Speaker 1 (44:17):
Wages to see that. Yeah, yeah, well, this is so fascinating.
Your practice has expanded exponentially with this new adventure that
you've joined. Very interesting to learn more about the challenges
facing women in each of their decades. We have to
pay be very aware of women listening about this, and
so to men. It's a very interesting time in medicine,
(44:40):
and I applaud your efforts. It's really great and I
look forward to your book.
Speaker 2 (44:44):
Thank you so much for having me and allowing me
to speak today. I think we're at a great time in medicine.
We're about to crack through some issues.
Speaker 1 (44:50):
Well, that is excellent to know. Thank you, doctor Pointer.
Host
Martha Stewart
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