Vai Kumar: 0:22

Hey folks, welcome to a new season of podcast, Fresh Leaf Forever. After all that focus on sustainability in season three of the show and after a good six, seven weeks of break, here we are back with Dr Jayne Morgan, a returning guest on this show. Hey, Dr Morgan, welcome to the podcast One more time.

Dr.Jayne Morgan: 0:42

Thank you, I love being here Awesome.

Vai Kumar: 0:46

So today we are here to talk about women's health. I know you have been a phenomenal spokesperson with your Stairwell Chronicles, trying to create awareness and educate the public on all things. First you started with COVID and then you transitioned to your area of expertise, cardiology, and right now you're focusing, I see, a lot on women's health as it relates to the hormones and the impact on cardiological health. So that's a great topic to start this season with, and I'm delighted.

Dr.Jayne Morgan: 1:20

Yeah, I love it and I'm so happy to come and talk about it. You're absolutely right. I focus a lot as a cardiologist on heart health, but specifically on women's heart health. Women have been excluded from clinical trials. Our symptoms are not well characterized or recognized. Heart disease still remains the number one killer of women, not breast cancer, even though breast cancer is important. We need to make certain that we understand the importance of the heart, because that's actually what is killing us more than any other disease process. And then, when we mix in menopause and perimenopause and pregnancy complications, we really start to gather steam, and so I'm happy to sit here and chat.

Vai Kumar: 2:03

Sure, sure, and one of these days we should, should get an in person recording to. Why don't you what viewers with what you are doing these days? Because you are like doing a whole lot for the society, a whole lot for the medical community, so why don't you get us started there? And then kind of transition to the impact of hormones on women's health.

Dr.Jayne Morgan: 2:29

So one of the things that I really like to talk about are the symptoms of perimenopause that women may not even be aware. Let's just start at the beginning. What is perimenopause? People have heard of menopause, but what's perimenopause? And perimenopause really are all of those years before you hit menopause, and menopause is described as you've gone one year without having a menstrual cycle. Once you've gone a complete year and haven't had a menstrual cycle, then you are officially in menopause. But what's perimenopause? Perimenopause are those 10 to 15 years before that, and why is that important? The reason that that is important is because it's during perimenopause when your estrogen levels start to drop. Actually, what menopause is characterizing is the ovaries have stopped. I guess you stopped ovulating. It's called ovarian failure. I hate using those words, and that's another thing that I talk about often is the language that we use around women cervical incompetence, these types of things. We don't really want to use those words.

Vai Kumar: 3:40

Oh, not too strong. To the point that people start panicking.

Dr.Jayne Morgan: 3:43

Right, people start panicking right, right, right, and so this is a part of the normal and beautiful not only aging process of a woman, but another transition in your life. Women go through so many beautiful phases and we should embrace this phase as well, and I talk a lot about that. So back to what I was trying to say perimenopause. Perimenopause actually starts in your mid-30s and people aren't aware of that. You're having regular menstrual cycles or your life is moving the way it normally has, but unbeknownst to you. You're starting to get little decreases in your estrogen levels, and so how would that manifest in your body, where you may not be aware? I mean, you may have little things like itchy ears, and the reason your ears are itching is because estrogen increases sort of the elasticity and the moisture of your skin, and you have skin inside of your ears.

Dr.Jayne Morgan: 4:40

As your estrogen level drops that, your skin may start to become drier, and the first place you notice it would be the skin inside of your ears. You might have itchy ears. So think about that. You never thought about itchy ears Like, oh, does this mean that menopause is coming? So these are kind of little symptoms, you know. What we think about are hot flashes and night sweats and insomnia and fatigue and brain fog, but there are a host of other symptoms, including, as a cardiologist, heart palpitations. You might start to feel heart palpitations that could be alarming and send you to the doctor for a workup. So these are all things that I really try to make certain that people have information about, because information is power. And what do hormones really mean in our body and how does it help to make us feel good and more like ourselves or maybe off center and not feeling so well?

Vai Kumar: 5:40

So when exactly would one start to feel this perimenopausal symptoms? Did you say in the 30s itself?

Dr.Jayne Morgan: 5:48

Yeah, even as early as the 30s, symptoms that you may not associate with menopausal symptoms, like itchy ears, like palpitations, like a change in body odor, if you start to notice that your deodorant just doesn't seem to work anymore Deodorant you've always used and now suddenly it doesn't seem to work. Or you're having to wash two and three times a day and you've got a drawer full of deodorants that you've been sampling at all the pharmacies and none of them seem to work. Those are some of the symptoms of menopause. Your estrogen level drops.

Dr.Jayne Morgan: 6:23

All of these things can impact your body, including forgetfulness or difficulty in concentration, which we term as brain fog, which could have serious impacts on your career, your career trajectory, how you perceive others at work, how they perceive you, how you perceive others at work, how they perceive you, and you're struggling. These could all be symptoms, again, of perimenopause that we don't think about Brain fog, change in body odor, you keep switching deodorants, and these are the kinds of things that you may not even be aware of, you may not be thinking about, you're just living your day-to-day life, but these are all signs that you are in perimenopause and these are not symptoms that we normally discuss.

Vai Kumar: 7:13

Okay, what about normal menopause, then, when it comes to from the standpoint of age and with you having brought up itchy feeling in the years and that's like skin related, could you feel any sense of burning in your skin as well? Is that, like you know, say some sporadic ones here and there?

Dr.Jayne Morgan: 7:35

Vi such a great point. Yes, you can have burning in the skin, and we should think about the skin, because the skin is actually the largest organ on our bodies, it is our biggest organ, and so itchy ears might be the first symptom of dry skin, but ultimately you will start to see that on your face and in your hands and in your body with those fine lines and wrinkles as your skin becomes drier and drier. So it's not really so much that you get older and you get wrinkles. The reason you get wrinkles as you get older is because your estrogen levels are dropping. Now, obviously, men also get wrinkles, and so it is part of the aging process losing some of that elasticity. And elasticity in the skin is not all estrogen related. It's collagen, it's vitamin E, it's a lot of things, but estrogen is one of those things that does give us some protection with the skin.

Dr.Jayne Morgan: 8:34

We've got estrogen receptors, though, in every organ of our body, so we've got estrogen receptors in the heart. Estrogen is cardioprotective, it's anti-inflammatory for the heart, and so the risk of heart disease for a woman is half that of a man prior to menopause, but by the time she enters menopause and those estrogen levels are at their nadir, meaning their lowest point. Her risk, or our risk, of heart disease is equal to that of a man, and by the time you reach 70, it actually exceeds that of a man. That's because we lose the protection of estrogen on our hearts. Estrogen receptors are in the lungs. They're in the bones.

Dr.Jayne Morgan: 9:17

When you think about another subtle symptom in perimenopause, in your 30s or early 40s, you might start to have bone pain or stiffness in your bones or inflammation. Is that really related to arthritis or getting older, or is that related to your hormones changing, increased bone resorption that you get? As the estrogen levels decrease? When I say bone resorption, your bones can actually become a little thinner and increase your risk of being brittle or breaking or having fractures. So these are all things. Estrogen is not all about the uterus and the ovaries. We have estrogen receptors in the heart, in the lungs, in the bones, in the skin, in the GI tract, in the liver, so all over the body, and so we can have all kinds of symptoms in all of these organ systems.

Vai Kumar: 10:10

And from your recent cardiology conference, like early part of the year, I know one of your Stable Chronicles post talked about the varying result based on estrogen and the impact on heart health. Correct, right? So, going back to what is a normal menopause, could women then reason out okay, whatever Dr Morgan listed out, I may be experiencing it at some point or the other. So can they feel at peace knowing that, okay, I'm transitioning into normal menopause? And what age would that be? And certain women, due to ever so many reasons in the world these days environmental or whatever, however, our food supply is what we eat, so on and so forth seem to be experiencing this at different age groups, right? So what exactly would you say is considered very normal and what would make someone feel like okay?

Dr.Jayne Morgan: 11:12

this is code red. I need to go to my physician. Yeah, I like that code red. It's all code red. I'm going to go back and just at the very beginning of what you commented on. So I recently went to the American College of Cardiology conference in April. It was in Atlanta, and what Vi is referring to is that there was a menopause talk there. The good news is that there was a menopause talk there, had not seen one there before. The bad news is that it was relegated to a side room. There was barely anybody there in attendance. But this actually was at a huge cardiology conference and so in some ways it's starting to make headway.

Dr.Jayne Morgan: 11:53

The association between menopause and perimenopause and heart disease. That particular talk was very specific to the risk of stroke during perimenopause and menopause. Stroke during perimenopause and menopause and your risk of stroke increases with the severity and frequency of your hot flashes. And what they found in that study is that the more hot flashes you have per week, the higher your risk of stroke, because the carotid arteries that are on either side of your neck that feed oxygen to the brain become thicker on the inside relative to the number and the amount and frequency of hot flashes that you have, and so, once again, these symptoms of menopause are not innocuous. They're not sort of ha ha ha, look at her, she's hot.

Dr.Jayne Morgan: 12:50

Hot flashes actually are an indicator that you've got an increased risk of not only heart disease but also stroke. So I want to make certain that we draw that parallel and that we understand that it's not really a laughing matter anymore. I mean, you see women sort of ripping off their jackets and shirts and they're so hot. These hot flashes actually can have very serious medical consequences for women, especially down the road, and so we're starting to recognize that we don't have a lot of clinical trials that are actually focused on women, where women are enrolled, but we're pushing that as well from the legislative side, and so all of these things are really very important, and so when we talk about Code.

Dr.Jayne Morgan: 13:37

Red. When are we getting to Code Red? So paramenopause is generally starts in the mid 30s, so maybe around 35 to 55. Menopause is generally somewhere between 50 and 62, right, depending on the woman. And again, menopause is when you actually stop having menstrual cycles. You're one year out from having those menstrual cycles. What's interesting is when we look at Black women here in the United States, generally Black women enter menopause about a year earlier than white women, and there are a number of reasons for that, including increased stress and something I talk about with weathering, with the racial construct of America and being a member of an easily identifiable double minority so you're easily identified as both Black and female and that dual stress. But not only might women go into menopause a year earlier, black women, that means that your risk of heart disease begins to increase a year earlier as well, and so it is not inconsequential. The effects of weathering, the effects of a racial society and how that really impacts your morbidity and mortality long term. The stress and heart disease, well-being, mental health it is really all interconnected.

Vai Kumar: 15:08

Then have any remedial measures been discussed? I know there's more studies coming up and stuff like that, but what then could someone do at this point? Because I don't want listeners to kind of go into a panic mode when they hear that oh hey, I'm experiencing so many heart flashes, then does that mean, with me hearing, I'm at a greater risk for stroke. I should just feel so anxious right away. What is it that they can do? Is like improving estrogen levels? Is like hormone therapy a solution, or what is the way to go?

Dr.Jayne Morgan: 15:46

So let's break that down. We actually know several things. As you're going through perimenopause and entering menopause, your cholesterol levels begin to increase. Your blood pressure increases. You can begin to develop more fat deposits around the midsection. We call that visceral fat and that visceral fat is actually more dangerous than other types of fat, because that fat that sits around the middle also encases the organs inside your body where you don't see, and so there's several things you can do to combat that.

Dr.Jayne Morgan: 16:21

Be prescribed an anticholesterol medication or a statin therapy. Women are less likely to be prescribed cholesterol medication and, when prescribed, are less likely to take them. Take your medications and control your cholesterol. If your blood pressure is increasing during perimenopause those years again a 35 to 55, take medication. Do not avoid medication. Take medication and bring your blood pressure down. Why do I say that?

Dr.Jayne Morgan: 16:50

Cholesterol is a risk factor for heart disease? Hypertension is a risk factor for heart disease. You can end up getting both during perimenopause. So you want to decrease those risk factors. You've got central fat that's sitting around the midsection very hard to get rid of as a woman gets older because of these drops in estrogen levels. So it may be time to have a discussion with your physician regarding whether or not hormone replacement therapy is right for you, meaning an estrogen patch or an estrogen spray, something to that degree and those are conversations that you have to have based on your individual and personal medical history.

Dr.Jayne Morgan: 17:35

Sleep we know that sleeplessness, insomnia and the lack of a duration of sleep also increases your risk of heart disease, and this is another symptom of perimenopause, where you can have a lot of sleeplessness, so another risk factor for heart disease. So really focus on sleep hygiene. So the point that I'm making if you get nothing else out of this podcast today is that your symptoms of perimenopause should be addressed. You should not just suffer through those symptoms and tough it out, because those symptoms are actually correlated with heart disease and stroke. So make sure you are taking care of those symptoms. Those symptoms are a warning sign and an indicator of future risk.

Dr.Jayne Morgan: 18:31

So when you're developing those symptoms, don't think that you should just suffer through this and suffer with migraines and suffer with menstrual cramps a normalization of our culture that women are to suffer. But what I'm also saying is, in this case, suffering actually can increase your risk of dying or having a problem later on. So you absolutely do not want to suffer. You want to address your blood pressure. You want to address your cholesterol. You want to address your sleeplessness. You want to address the weight around your midsection. We can talk about that Anti-inflammatory foods, weight resistant, exercising like Pilates and other types of things where you can increase your bone density and begin to work against that fat that is depositing around your midsection.

Vai Kumar: 20:20

Okay, wonderful, you talked about certain populations being at a risk for heart disease in general, and also menopause and heart disease in particular. Right, you touched upon the African-American population. What about, say, the Asian population? And what about other race, and do you see any marked differences?

Dr.Jayne Morgan: 20:44

between groups, and the reason that that is a better question than you probably even know is because these groups are not studied in clinical trials, right? So we don't have that information. We do have information on Black women from the Women's Health Initiative, which is an entirely debunked study. I'm not advocating any of the findings from the Women's Health Initiative. However, there were Black women in the trial and those subgroup analyses have been very important for us to really understand the impacts of estrogen on the body, especially since most of those women had had hysterectomies and that's another conversation as to why Black women are subjected to hysterectomies in this country. But what that served in that particular trial is it allowed us to see what estrogen actually does on women, as opposed to estrogen and progesterone, and so so much work needs to be done on all cultures.

Dr.Jayne Morgan: 21:48

I talk about this a lot, even outside of women's health. With regard to my most recent stairwell chronicle, that I did for Juneteenth was really about white blood cell counts and what's a normal white blood cell count? And all of these normal values have been based on people of European heritage and descent, and we actually find out that other cultures actually have different normal values, but we characterize these cultures as having abnormal values, because it's always compared to the normal value, which is all people of European heritage, and then people can be subjected to unnecessary tests, unnecessary pain, unnecessary expense, and so I say that to say you hit the nail on the head, vi. We don't have that information that we actually need to have on all peoples in our global society and not just the white race and specifically the white male sector of our society.

Vai Kumar: 22:53

Okay, you touched upon white blood cell count. So does it mean having a low count is dangerous or does it mean a high count usually, typically, is significant of some infection, correct?

Dr.Jayne Morgan: 23:05

Yeah, and so both white, just both high and low. I'm using these in quotation marks because, again, the normal range is based on people of European descent. So what we know is that people of African and Middle Eastern descent tend to have lower white blood cell counts, and so, generally, the lower your white blood cell count, the more at risk you are for infection, and or it can be an indicator that you've got some other disease process going on in your bone marrow, something very serious. But as it turns out, as we're getting more and more data, it may be that these populations that have descended from Africa or the Middle East actually have a lower white blood count for whatever reason in evolution, and it doesn't mean that anything is wrong. It just means that we're being compared to a standardization of a different population. And so these are all the things that, in medicine, really, really need to be unraveled, because healthcare does not serve all populations equitably in this country for a number of reasons. That's just one of them.

Dr.Jayne Morgan: 24:24

I talk about a number of things, if anybody would like to follow me.

Dr.Jayne Morgan: 24:29

What Vi is talking about is I do something called the stairwell chronicles, and I literally sit on the stairs of a house and I answer one single question about medicine in 60 seconds or less. I generally do these on Wednesdays about a topic really of my choice, and sometimes people write in and say hey, I'd like to know something about X, y and Z and I might create a Steroid Chronicle. You can follow me at Dr Jane Morgan D-R-J-A-Y-N-E-M-O-R-G-A-N on Instagram, but you can also find me on all the other platforms, including LinkedIn. Do talk about algorithms and formulas that are race-based within medicine, that can relegate different people, including people of Asian American backgrounds, asian backgrounds as well to lower levels of care and concern, and these are actual formal formulas and calculations that we use every single day in medicine that are again based on the normalcy of the white population and it doesn't take into account any other people outside of that race, and so people who fall outside of that range then are considered abnormal, and so that's how that happens.

Vai Kumar: 25:54

Okay, I just have a question. When you pointed out the varying scenarios the impact of estrogen on cardiological health, hypertension, cholesterol, whatever it may be right, or even the occurrence of heart flashes, the periodicity of it, the frequency Right, and someone notices that, do you think they are able to go and address that with their physician? Are the physicians equipped enough with the data to answer it? Or are they just brushing aside patients saying, hey, this is just part of the process, because we talked about women having to endure this, correct, so we talked about that. That's part A of that question, and then part B would be then is the answer to it lies in the individual taking it on themselves and focusing more on, say, movement, diet, lifestyle and those kinds of factors.

Dr.Jayne Morgan: 26:49

Yes, yes, yes and yes. So doctors are not as well informed as they should be, because this continues to be a burgeoning study and we're having to unlearn what we were taught in school from the Women's Health Initiative and unlearning something is always more difficult than learning it the first time and so that is an uphill battle, and so most physicians will not be armed with the most up-to-date information on women's health, menopause up-to-date information on women's health, menopause and hormone therapy, and you may be bringing information to them. The other thing you should think about is you can look up physicians and perhaps other types of healthcare providers who are menopause certified, because then they're able to work in conjunction with you and they actually have an interest in it and have studied these hormones. Generally, we see that with obstetrician gynecologists, but I'm working hard to have cardiologists also begin to be a part of this, because so many of the long-term effects of perimenopause and menopause are cardiac related, and cardiologists really have got to get involved in it. So, yes, you would need to advocate for yourself in many respects A lot of the symptoms that I talked about earlier in menopause.

Dr.Jayne Morgan: 28:22

Doctors have no idea what you're talking about If you come in to say, hey, I'm 41 years old and my ears are itching and I kind of have a bad taste in my mouth and my deodorant doesn't work anymore. They are probably going to look at you cross-eyed. That means nothing to anyone, right? We haven't studied those symptoms.

Vai Kumar: 28:40

What about OBGYNs? Do you think, at least right now, they are able to answer these?

Dr.Jayne Morgan: 28:46

or I do not, but, um, I think this whole world of perimenopause and menopause and hormone replacement therapy is penetrating that specialty faster, okay, than any of the other specialties okay, yeah, what about role of movement, diet and lifestyle?

Dr.Jayne Morgan: 29:06

um, all of that is so important. I mean movement, diet, exercise. All of that is important in just taking care of yourself outside of menopause. When we add perimenopause and menopause to it, it really becomes paramount because an anti-inflammatory diet and generally at a high level an anti-inflammatory diet is a diet that is high in plant-based foods and fruits and even lean, lean cuts of meat in small portions, and that protein is really important. When I say protein, I mean the protein sometimes that we get in meat, but you can get it in beans and other things. The protein is so important as a woman ages because we lose muscle mass and the protein helps us maintain that muscle mass. But also weight-bearing exercises and you don't necessarily have to go to the gym and pick up weights and start doing those weights, but you can do things.

Dr.Jayne Morgan: 30:09

I teach Pilates. You can do things where your body is being used as the weight and you are learning resistance and at the same time, you are incorporating movement of your body. It is important to move period and not just Pilates. I mean just getting up and walking and being mobile and making certain that you are not necessarily staying active but remaining mobile, because we know that societies that remain mobile actually have longer lifespans than those that lead more sedentary lives, including sedentary meaning more industrialized or digitalized lives that make things easier for us. That ease of life actually can, in the long run, take years off of your life, and we see that societies where movement is a part of what they have to do every day to live. Actually, we're studying these societies because many people live for many, many long years. There are many centurions in these types of societies, meaning they live to be a hundred or more.

Vai Kumar: 31:21

Oh, that's the blue zone we are talking about, right, the blue zones.

Dr.Jayne Morgan: 31:24

That is correct.

Vai Kumar: 31:26

Yes In the show earlier, and when you said movement, I can attest to it. I think the viewers, listeners of this show know pretty darn well that I myself wrestled with inflammatory bowel disease, but I've learned to manage it really well. In fact, I am a student of your Pilates program as well, so I'm proud to share that with listeners here. I can personally attest to movement Every time. I walk several thousand steps or I do hiking, I do a combination of yoga and Pilates. My bone density and my inflammatory markers have really even become normal.

Vai Kumar: 32:08

Of course, what we eat in this part of the world, the food supply, the dietary practices, everything is quite different and I would just certainly encourage listeners, viewers, to make sure that, whatever is possible, make sure that you cook fresh food, eat and lead a very healthy lifestyle. You took us through the role of movement and I shared my two cents on it. What about the hours of sleep? I know we all live in a digitized world, hooked to our phones, and I guess I sound like a broken record, sometimes even on this very own show, talking about hey, people don't be on your devices all the time.

Dr.Jayne Morgan: 32:51

Yeah, yeah. So when we talk about sleep, the studies have shown that people who get six hours or less of sleep per night have an increased risk of heart disease. So six hours seems to be the sweet spot. Again, more research needs to be done and we need to really kind of look specifically at different groups and different populations specifically at different groups and different populations.

Vai Kumar: 33:18

Okay, what about mental health, the impact of mental health, and does estrogen levels have any impact on mental health? And in fact, I also meant to ask about varying estrogen levels and, potentially, people getting blood clots as well.

Dr.Jayne Morgan: 33:34

Estrogen receptors are found in the brain as well, and so no surprise. As estrogen levels begin to drop during menopause, you can start to have changes in your brain and the way that you're thinking and the way that you're experiencing life, and it's no surprise that the most number of antidepressants are prescribed to women during this phase of their lives. But the question is are we really depressed or are we just in perimenopause? Do we really need antidepressants or do we need to think about what's going on with our hormones and whether there are other options? And so just another great example of estrogen receptors being in other places other than our uterus and our ovaries.

Dr.Jayne Morgan: 34:29

We know that mental health is very connected to physical health.

Dr.Jayne Morgan: 34:34

In fact, people with higher levels of depression and anxiety also seem to have shorter lifespans as well, sometimes by as much as 10 years, and so mental health drives how you move when you move, whether you feel like moving or whether you're going to sort of adopt a sedentary lifestyle, whether you'll be just sitting at home, whether you will close yourself off from society All of those things you think are just mentally related. But it really is now having an impact on your physical health, and then later it will have an impact on your health overall, whether or not you start to self-abuse. So drinking more alcohol or smoking more, or indulging in illicit substances and drug abuse, or taking more prescription and non-prescription pills All of these things can be a part of mental health. That actually, then will eventually impact your physical health, including overeating and indulging in all types of foods that may provide short-term satisfaction high in sugars sugar highs but long-term may high in sugars sugar highs but long-term maybe pushing you towards diabetes and obesity and hypertension and high cholesterol. So mental health is incredibly important.

Vai Kumar: 36:06

And you said a lot of things women are just kind of told to endure, right? So in terms of mood swings and things like that, what about? The answer Again, is estrogen level contributing to how your mood sways and how you kind of present yourself? So how can society be much more forgiving and accept a woman and embrace her for who she is?

Dr.Jayne Morgan: 36:32

And be more supportive and be more supportive. I mean, the word menopause isn't even a part of any HR department at any company or any corporation or any organization, and so women are just managing it on their own, with fans under their desk or fans sitting on their desk to blow on them. And again, we're thinking of this as, oh, she's just hot. But what we should be thinking of is, oh my gosh, her risk of heart disease is going to be increased. Perhaps we need to have some way of supporting her in this environment where she is suffering and struggling and trying to adopt and adapt. Even someone who's bringing extra shirts to work because they know they have to wash in the middle of the day and freshen up and things are just different for them. And they're struggling in this society and in a work environment where they may be having brain fog, challenges with memory they didn't sleep well at night. They don't feel well. They go to the doctor. They're told they should just suffer. There's nothing wrong with them. They're having palpitations. They've been to the cardiologist. There's nothing wrong with their heart.

Dr.Jayne Morgan: 37:44

Eventually am I losing my mind and there's no support for it. So you are absolutely correct and the support of friends and your community has really been shown to actually be more important than even the support of a spouse. That environment and community and friend support. And so absolutely talk with your friends, make sure you have a community, have shared experiences, people shared experiences, People support you. And then look for people who are certified in menopause and menopause specialty to see if you can have a conversation and start to connect those dots and then you can take that information to your physician as well and begin to have that conversation with them also information to your physician as well and begin to have that conversation with them also.

Vai Kumar: 38:43

Okay, we'll come to much more of social engagement in a bit, but again, just to refresh on that question from before what about estrogen impact on, say, potential for blood clots and things like that?

Dr.Jayne Morgan: 38:51

Yes, and so the data from estrogen on blood clots came from the route of administration. So there are many different ways you can take it. You can have a spray, you can have a patch, you can have a cream. You're going to have a pill, so it's the pill form that has the greatest risk of blood clots. If you're taking it in a pill form which really almost just isn't done anymore, a pill form which really almost just isn't done anymore, however, it's still relatively safe. But the highest risk of blood clots comes from the pill form.

Vai Kumar: 39:25

Okay, thank you. What about, say, tools that one can empower themselves with? Would that be when we talked about diet and lifestyle? When you said anti-inflammatory just for listeners to have a very clear picture does that mean eating more whole grains, eating more plants and more vegetables and fruits like a colorful plate? You talked about the role of protein in muscle mass and everything. So what would be Dr Morgan's advice to someone in terms of, say, a reasonably good diet and lifestyle practice?

Dr.Jayne Morgan: 40:04

All of the things that you've said. I mean, you nailed them and that's not just for perimenopause and menopause. This is an adaptation of living a healthy and whole life, and so those are the types of foods that are anti-inflammatory. Generally, that is more of a Mediterranean and a plant-based diet. Why is that important? We keep talking about anti-inflammatory, but I haven't told you why.

Dr.Jayne Morgan: 40:31

Inflammation, chronic inflammation in the body, is one of the things that creates heart disease. It creates the hardening of those arteries. It contributes to that. People who have chronic inflammation also have a higher risk of what? Of cancers, of autoimmune diseases, of arthritis, of GI diseases, meaning your stomach and your gut. So we know that chronic inflammation is a causative factor for disease processes in the body. So when we keep talking about anti-inflammatory things, that's why anything that you can do that can reduce the chronic inflammation in your body is going to be beneficial to you, because inflammation increases disease processes, including all kinds of things, including heart disease as well. When we talk about inflammation, obesity is a driver of inflammation. Inflammation is a contributor to obesity, so it's a two way street. Obesity, though, is a risk factor for heart disease. You can see how everything sort of compounds on itself, and so it's important to have a healthy lifestyle independent of perimenopause and menopause, but then, as women enter this phase in their lives, it becomes an importance of greater paramount.

Vai Kumar: 41:52

Great. What about? Even girls these days say, hey, you know what? I think I'm so bloated during the time of the month or whatever, and everyone wants to be a size zero. I mean, we all live in a social media world and everyone is so image conscious. There's some good, but there seems to be so much of pressure. Society wise for women. How does a woman fulfill social obligations but also take care of herself? Dr Morgan, and I guess one doesn't want to feel lonely, correct? I think you started touching the impact of a community and yeah, and I think there's common misconception or is it really a misconception that if you get to menopause, you will put on weight. So how does anyone combat all of these?

Dr.Jayne Morgan: 42:38

Yeah, loneliness is definitely a risk factor for decreased lifespan, and so we have to think about what that is in this society with all this social media, but are people actually lonely when we talk about risk factors as well? As we transition through all of these phases in our lives, community is incredibly, incredibly, incredibly important, and that connectivity it turns out. In the end, humans are very social species, and so that community and that interaction outside of the digital interaction turns out to be very important, not only for mental health, but for your heart health as well. We've already connected mental health to your physical health, and so taking care of your brain, taking care of your psychological well-being, is self-love, because that also takes care of your brain. Taking care of your psychological well-being is self-love because that also takes care of your physical well-being.

Vai Kumar: 43:42

Okay, perfect. What about questions? Just to bring it to a very granular level, what about questions? Every woman should ask their doctor for them to know that they are giving themselves the right kind of self-love, they are arming themselves with the right kind of protection upfront, rather than having to say, kind of face the music later.

Dr.Jayne Morgan: 44:07

Yeah, you want to make sure that you get an EKG at your appointment, not because you're sick, not because you're having chest pain, but every woman needs to have that baseline EKG. So if you ever come in with symptoms later and we get an EKG, we have something to compare it to, to what it looks like at a different time, and oftentimes that is never ever done. So request an EKG, not because you're sick, but because you want a baseline status in your chart. Not because you're sick, but because you want a baseline status in your chart. You want to also talk about what some of your symptoms are and whether or not it's time to discuss hormone therapy, whether you're interested in it or not, and what are the options are available to you.

Dr.Jayne Morgan: 44:51

You know, vi, you hit on something that is actually very true and it's actually very funny, but it's.

Dr.Jayne Morgan: 45:03

Is it just impossible to get rid of weight as you're going through perimenopause? It really is very, very hard. The physiology of the body is designed to hold onto fat and to hold onto calories right, because we weren't always living in the types of societies that we're living in. As your estrogen levels drop, that even becomes harder, and that's why you can often hear women say I'm eating the way I've always eaten and I always exercise and I'm still gaining weight. I mean, what does that mean? And that is part of it, and women who are on hormone replacement therapy actually are way less than women who are not on hormone replacement therapy. It's not a reason to take it, but it's something to understand. With regard to how estrogen works in our bodies, and we've talked a lot about estrogen, but there's also progesterone and there's also testosterone that we really associate with men, but women actually have more testosterone in our bodies than estrogen and we actually lose more testosterone as well, which is why we also have difficulty holding onto this muscle mass.

Vai Kumar: 46:15

What about the role of, say, dietary influence, like soy products and things like that?

Dr.Jayne Morgan: 46:21

Yeah, we look at soy and estrogen. So there is no limit really on taking soy. There are no studies on comparing soy to actual estrogen therapy. Again, we're going back to clinical trials, so I can only tell you kind of what we think. And soy is something positive to be incorporated into your diet along with other plants. Soy in particular tends to bind to the same receptors as estrogen, but we really need to have clinical trials and better research on it.

Vai Kumar: 46:53

Okay, perfect. I think that's a lot of great insights, dr Morgan, on all things wonderful when it comes to keeping oneself healthy, keeping oneself empowered, asking the right questions, just staying on top of it with your annual physical visits, and so on and so forth. I think there were huge insights into the impact of cardiological health and what one should not ignore, and also for women to feel at peace, knowing that they are not alone, feeling some of the symptoms, and I think watching and listening to a podcast like this is going to help them feel that they are not alone, but not to resist or detest themselves from taking action. So thank you once again for joining us and empowering us.

Dr.Jayne Morgan: 47:41

You're welcome. I'm glad we finally got this done again. Love it.

Vai Kumar: 47:44

Yes, yes, listeners, as always, follow the podcast, rate the podcast, leave a review from your podcast app of choice. Follow us on YouTube @vaipkumar, that's V-A-I-P-K-U-M-A-R, and across all podcast sources. Until next time with yet another interesting guest and yet another interesting topic. It's me Vai, along with wonderful Dr Morgan, saying so long, so long.

Dr.Jayne Morgan: 48:11

Thanks everybody.