14. Perimenopause: Cardiology with Dr. Lisa Larkin
Cardiovascular disease is the No. 1 killer of women nationwide, yet during midlife—the crucial time for prevention—many women fall out of regular medical care.Host Dr. Rachel Pope is joined by Dr. Lisa Larkin, an internal medicine and women's health expert and founder of Ms. Medicine. They discuss why women's cardiovascular risk spikes around menopause and what you can do about it now.The Midlife Risk SpikeDr. Larkin highlights a failure in the healthcare system: women aged 40 to 60 often receive the least medical care, right when prevention is most critical.The perimenopausal transition causes rapid and significant metabolic changes: Cholesterol rises and HDL protection declines. Development of insulin resistance. Increase in visceral fat (the "risky fat" around organs), which is a marker for cardiovascular disease.Standard risk tools often underestimate risk in women because they don't account for sex-specific factors like adverse pregnancy outcomes (preeclampsia, gestational diabetes). Women are also often allowed to run higher blood pressures, missing opportunities for early intervention.Management & The "Missed Boat" QuestionDr. Larkin stresses that Body Composition is more important than BMI, as most women gain risky visceral fat during this time. She recommends tracking body composition annually.For women in their mid-60s who ask if they've missed the boat on prevention or Hormone Therapy (HT): Assessment is Key: Dr. Larkin performs a highly individualized assessment, often utilizing a Coronary Calcium Score to check for established plaque. If Risk is Low: A patient with perfect health metrics and a Calcium Score of zero may still be a candidate for HT to treat symptoms and support bone health. If Risk is High: The priority is to aggressively fix every single risk factor (hypertension, elevated lipids) before considering hormones, as established plaque may carry more risk with estrogen.Dr. Larkin emphasizes that women must be their best advocates because the healthcare system is currently failing to provide the comprehensive care needed during this pivotal stage of life.
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13. Perimenopause: Cognitive Changes with Dr. Rita Shkullaku
This episode addresses a terrifying but common experience for midlife women: the cognitive changes, or "brain fog," that pop up during perimenopause and menopause. Many women fear they are experiencing early-onset dementia.Host Dr. Rachel Pope speaks with Dr. Rita Shkullaku, a board-certified internist with a special interest in nutrition, obesity, and hormones as they relate to cognitive wellness and healthy aging.The Reality and Biology of Brain FogDr. Shkullaku confirms that brain fog—forgetfulness, concentration issues, and a blank mind—is very real. She notes that having "mild cognitive issues for eight to ten years has no small impact" on high-functioning women.The problem stems from both: Direct Effects: Estrogen drops affect the brain’s ability to use the prefrontal cortex and manage stress. Indirect Effects: Severe sleep deprivation from night sweats and hot flashes dramatically worsens cognition.To distinguish serious issues from hormonal brain fog, Dr. Shkullaku uses the Self-Report vs. Intervention rule: women with typical brain fog are aware of their struggle, while those with true early dementia are often unaware and brought in by family.Practical Strategies and TreatmentManagement requires a holistic approach, starting with the foundation: Prioritize Sleep: Address the underlying hormonal issues or anxiety that keep you awake. Redistribute Responsibility: Normalize the struggle and ask partners/family for help to create time for self-care. Complex Cognitive Training: Pick up a new complex activity (like a new instrument or language) to engage the brain differently. Nutrition: Follow the MIND Diet (a hybrid of the Mediterranean and DASH diets).Treatment: If medically eligible, Hormone Replacement Therapy (HRT) is a great option, primarily by eliminating sleep-disrupting symptoms. If not, Cognitive Behavioral Therapy (CBT), mindfulness, and addressing reversible causes (like iron or B12 deficiencies) are crucial.
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12. Perimenopause: Kegels, Squats & Pelvic Floor with Dr. Karen Connor, PT
In this episode of Perimenopause: Head to Toe, Dr. Rachel Pope sits down with Dr. Karen Connor, a seasoned physical therapist with over 20 years of experience, to discuss how perimenopause and menopause affect the pelvic floor. Dr. Connor shares her extensive expertise in pelvic health, shedding light on the changes women experience during this stage of life and how pelvic floor physical therapy can help manage and prevent complications.Key Highlights: What is the Pelvic Floor? Dr. Connor explains the role of the pelvic floor muscles, their importance in overall health, and how they provide support for vital organs. How Perimenopause Affects the Pelvic Floor: Learn how hormonal changes during perimenopause and menopause lead to tissue thinning, reduced elasticity, and muscle weakening, all of which can affect pelvic floor health. Pelvic Floor Exercise: Dr. Connor emphasizes the importance of pelvic floor exercises like Kegels, and why combining these with other physical therapy techniques is crucial for comprehensive pelvic health. Heavy Lifting and Pelvic Floor Health: Dr. Connor shares her insights on lifting heavy weights and how it can impact the pelvic floor, offering practical advice on how to protect it. Managing Pelvic Pain and Prolapse: From pain with penetration to prolapse, Dr. Connor discusses how pelvic floor therapy can help women manage these conditions, even if they're already experiencing symptoms. The Importance of Working with a Pelvic Floor Physical Therapist: Dr. Connor highlights the benefits of seeing a pelvic floor physical therapist for tailored care and exercises that address the unique needs of each individual.For Women in Perimenopause and Beyond: Dr. Connor stresses that no matter where you are in your health journey, pelvic floor physical therapy can help manage symptoms and prevent future complications. Whether dealing with prolapse, incontinence, or pelvic pain, proper treatment can significantly improve quality of life.About Dr. Karen Connor:Dr. Connor is a highly experienced physical therapist, educator, and pelvic health advocate. She co-authored the book Sex in Your 60s and has served in various leadership roles within the American Physical Therapy Association. Dr. Connor currently runs a private practice, Cleveland Pelvic Wellness, alongside Dr. Jessica Jenkins, where they provide specialized pelvic floor therapy to women in Northeast Ohio.Resources Mentioned in the Episode: Cleveland Pelvic Wellness Website: clevelandpelvicwellness.com Sex in Your 60s (Book co-authored by Dr. Karen Connor) The Menopause Retreat - November 14th
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11. Perimenopause: Facial Plastic Surgery with Dr. Diana Ponsky
This episode features Dr. Diana Ponsky, a renowned facial plastic surgeon in Cleveland, Ohio, who leads Ponsky Facial Plastic Surgery. Double board-certified in Facial Plastic Surgery and ENT, Dr. Ponsky specializes in natural facial rejuvenation. She discusses how hormonal shifts impact the face and what women can do about it.The Hormonal Impact on AgingDr. Ponsky notes that a sharp drop in hormones around menopause can feel like an "acute switch" in aging. Collagen Loss: Women can lose up to 30% of their collagen within five years around menopause, followed by a 2% loss each year. Structural Changes: Low estrogen affects receptors throughout the skin and bone. This causes skin to become coarser, fat to descend, and even facial bones (like the jaw and areas around the nose) to atrophy, which can flatten the brow arch.Prevention and Maintenance: The "Car Tune-Up"Aging gracefully is about slowing down the process, which Dr. Ponsky compares to constant maintenance on a car. Proactive Care: Genetic predispositions mean some women benefit from early surgical prevention (like brow lifts or fat transfer). Lifestyle: Rigorous skincare, sun protection, and avoiding repetitive motions (like drinking through straws) are crucial for maintenance. The Role of HRT: Dr. Ponsky is a firm believer in Hormone Replacement Therapy (HRT), even starting in perimenopause, to slow the loss of muscle mass and bone density (including in the face).Treatment Options Fillers: These are volumizing agents (like hyaluronic acid) that replace lost volume; they do not lift. Dr. Ponsky cautions against overuse, as too much filler can distort muscle movement. Never Too Late: For those who missed the prevention window, aggressive treatments like deeper lasers and fat transfer can still yield great results, combined with a commitment to nutrition and a long-term care program.Dr. Ponsky reminds women that given we are living longer, tending to our bodies is necessary. It's not vanity; it's ensuring a high quality of life long after menopause.
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10. Perimenopause: Identity Shift with Sundae Bean
In this episode of Our Womanity features a conversation with Sundae Bean, a transformation facilitator who supports individuals and organizations as they traverse through life quakes and other major shifts. A trusted voice for navigating life between worlds, Sundae is currently dedicated to organizational transformation in Switzerland and is widely known for her podcast, IN TRANSIT.Perimenopause: A Biological TransitionSundae explains perimenopause as an externally led transition—something that happens to you, not something you choose. This can overlap with other life transitions: Internally Led: Changes that come from within. Performance Led: Pursuing a big goal, like a promotion. Externally Led: Changes that come from our environments.She emphasizes the importance of distinguishing between a genuine emotional response and a biochemical one, noting that while feelings are real, their source may be hormonal rather than a true reflection of your reality.Strategies for Navigating Hormonal ShiftsSundae offers practical advice to help manage symptoms like "monkey mind": Reality Check and Blood Check: Use this dual approach to test what's truly going on. Talk to a trusted friend to get an outside perspective, and work with your doctor to get yourself evaluated . Trust Your Body: Sundae shares her own experience of listening to her body's "yummy yes" for yoga over a "hard no" for running. This highlights the importance of trusting your body's needs over external advice. Find Your Body Compass: To counter feeling out of control, she suggests a simple exercise: take three deep breaths and hold the fourth until you can feel your own heartbeat. This grounds you and gets you out of your head.Perimenopause as a Growth OpportunityWhile difficult, perimenopause can be a time for growth. Self-Advocacy: It may force you to become your own best advocate, taking charge of your health when the system feels unsupportive. Adapting Strategies: Acknowledge that old strategies might not work now. A coach can help you develop new approaches. Bending Reality: Sundae encourages listeners to honestly assess where they might be "bending reality"—acting as if there are more than 24 hours in a day. This awareness is the first step toward delegating and prioritizing.Advice for Healthcare ProvidersSundae offers advice for healthcare providers to better support their patients. Listen to the Patient: Ask, "How have you been?" to understand the full context of their life. Validate Their Experience: Don't dismiss symptoms. A simple, "That sounds hard," can be incredibly validating.Refer When Needed: If you cannot provide the necessary care, refer patients to a coach or other specialist.
Dr. Rachel Pope, along with women's healthcare professionals, experts, and inspiring women, address commonly asked (and not asked) questions about, health equity, sexual health, menopause, perimenopause, reproductive health care, anatomy, aging and more. Whether you have questions about periods, pregnancy, or menopause, we will do our best to address them here!
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