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Are you feeling lost, overwhelmed, or disconnected during postpartum and perimenopause? It turns out the two share a similar path! Do you find yourself struggling with symptoms like brain fog, joint pain, or mood swings? It’s time to reclaim your power and voice during both of these transformational and powerful phases of your life.
In this interview, Dr. LaKeischa and Dr. Ginger dive deep into the challenges women face during postpartum and perimenopause and how it impacts not just their physical health, but also their emotional well-being. Through their candid conversations, they shed light on the importance of seeking help and support during these crucial times.
Join them as they discuss the need for holistic care, including functional medicine, integrative medicine, physical therapy and lifestyle changes to support your body through postpartum and perimenopause. Discover the connection between your pelvic health, vocal cords, and overall well-being, and learn how reclaiming your voice can empower you to navigate this phase with grace and strength.
Let Dr. LaKeischa and Dr. Ginger guide you on a journey of self-discovery and empowerment during perimenopause. It’s time to prioritize your health, embrace your unique journey, and find the support you need to thrive during this transformative time in your life.
You can watch the full interview on YouTube!
Dr. LaKeischa McMillan, MD is an OBGYN whose mission is to empower women for generations as they age to feel confident in knowing how balancing their hormones is essential to healthy living. Dr. LaKeischa graduated cum laude from Oakwood College, now Oakwood University in Huntsville, Alabama, with a bachelor of science in biology, and earned her medical degree at Loma Linda University School of Medicine.
In addition to her clinical practice, Dr. McMillan is also a speaker and writer on women’s health topics. She is also a contributor to several online and print publications. Dr. McMillan is committed to providing women with the information and resources they need to experience relief from their symptoms and make informed decisions about their health. She is a compassionate and knowledgeable physician who is dedicated to helping women live their best lives.
0:00 Dr. Ginger Garner: Hello, and welcome, everyone. Welcome back and Happy New Year. I am here with Dr. LaKeischa for a part two. So if you have not listened to part one, strongly, highly encourage and recommend that you go back and listen to part one. Because we started the fire there and we’re continuing it and it’s very appropriate that we’re kicking off the new year and talking about a really important topic.
Everything that has to do with menopause, perimenopause and all that jazz. I think it’s appropriate to pause here because menopause and the whole experience is demands that kind of respect.
0:58 Dr. LaKeischa: Now it does.
0:59 Dr. Ginger Garner: And, you know, before we kind of hit the record button and press play, so to speak, to talk today, Dr. LaKiescha, you and I were sitting there going, And I’m just going to tell it tell everybody the story if that’s okay.
1:18 Dr. LaKeischa: Absolutely, absolutely. I love it.
1:20 Dr. Ginger Garner: Yeah, I think that you were talking about something very similar because I had my oldest you know he had an appointment so I was dropping one kid and then rushing to the eye doctor so they could have the right insurance and then you know, pay that bill, come back. And then jokingly, I told you, I said, yeah, and just before, literally like seven minutes before this podcast was to start, I started rearranging my furniture so that I could.
1:48 Dr. LaKeischa: And I was like, of course, because this is what you do. This is what we’re supposed to do. It’s not foreign to me. This is not a foreign concept at all.
1:59 Dr. Ginger Garner: It’s 2024. Yellow is a bright color. There’s a woman in the background. [I love it. I love it.] And so I have to be honest. Now I’m sitting here and this, if you’re watching this on YouTube, I am roasting. Like I just moved a desk to make this happen.
2:20 Dr. LaKeischa: I’m laughing with you because I do the same thing. Like you said, I was rushing back from an eye appointment. I’m like shoveling snow, because it snowed here where we are. And I was like, oh, I want to be able to get into my parking space. I didn’t want to pack down the snow that was there. And so I was like, OK, let’s shovel, shovel, shovel. And then I ran upstairs, threw on my top, like, OK, powder, powder, powder, spray, spray, spray. So I have my fan blowing on me. [This is my fan.] So we are here together. We are talking about it.
3:00 Dr. Ginger Garner: Oh my word. I’ve got, I want to stretch and everybody can just take a big exhale and just blow out all the heat. Cause it’s there. Cause if it’s not from moving furniture and shoveling snow, it’s because we’re all pissed off because you can’t get good care surrounding perimenopause and menopause.
3:23 Dr. LaKeischa: Oh, that’s a great segue. Love that. Absolutely. Absolutely.
3:28 Dr. Ginger Garner: Yeah. So, okay. In all seriousness now, and I am also serious about you guys taking a big cooling exhale. In yoga, we actually moisten the lips and blow out through that. And you also inhale through it because it’s cooler. So if you’re roasting like we are right now, just try that. It’s a great cooling breath.
So given that love it, love it. Yeah, it is. It is very effective. I’m feeling better already. [Yeah, feeling more grounded.] Yeah. And that’s why we’re here. Get grounded to point you guys in the direction of the care that you deserve. And to bring you up to speed on where we were in part one, we discussed about the hows and the whys, why you left kind of the typical medicine as we know it, you know, in the system.
And just to give you a snapshot, and I know I’m preaching to the choir right now to everyone listening, but I just want you to feel validated that yes, our system is, um, it’s overpriced. It often neglects and dismisses women. and people of color. It mostly fans away a lot of smoke a lot of times instead of putting out the fire. When we’re talking about menopause y’all we’ve got a literal fire going on and that deserves to be addressed. So that’s where part one picked up. That’s our conversation. And so part of that firestorm that was started was that Women’s Health Initiative study, and that was in 2001 or two?
5:17 Dr. LaKeischa: It started in 1998, I believe, but it came to an early end in 2001. I’m sorry, 2002, 2001. And then the report came out in 2002, which then, yes, exactly, because they thought the statistic of the statistical analysis was showing an end point that was showing harm in the hormone stop. In the hormone arm of that women’s health initiative.
5:49 Dr. Ginger Garner: Yeah. And so in part one, we talked about setting the record straight because an entire generation of women were deprived of HRT, hormone replacement therapy. There are many different names that’s coming to be called, but so now we’re back in part two to finish that conversation.
And so when I was thinking, I was wondering if anybody’d ever say, okay, Dr. Lakei, let’s do this. And I was like, I wonder if anybody’s ever said that before. And it rhymed and it sounded good.
6:23 Dr. LaKeischa: Yes, yes, yes, yes. I’ll go with it. I will go with it. I will go with it.
6:29 Dr. Ginger Garner: All right. So that’s what we’re going to do today. And I was so moved by your story when you shared when you were in the hospital and you were being, it was just rushed. You were being dismissed. You didn’t feel heard or seen until they found out who you were.
6:50 Dr. LaKeischa: Yeah. Yeah.
6:52 Dr. Ginger Garner: That should cause all of us pause because, you know, yes, you were a fellow doctor as an OBGYN. And it just makes you go, whoa, it shouldn’t take being a fellow doc to get respectful treatment, to have people slow down, to have them consider what they were suggesting was a big deal and you needed time to process. And your story shines a really big light on that kind of inequity in medicine.
So I want to talk about how we can be kind of large and in charge of our pelvic health through our seasons of life. [Absolutely.] You know, one of the first times I think we might realize it is, and that is if you’re one of the lucky ones who your periods are okay and you just kind of, you know, you have a relationship and at some point you go, you know, I think I want to have kids and then you get pregnant and then there’s no problem. Right.
That doesn’t happen for a lot of us. I know it wasn’t for me. It was a long, awful, painful road to even get to the point where I could then experience the long, painful road of postpartum, right? So I think one of those first times that in our life where we might feel the fallout of hormonal changes, if we’ve had a smooth go up until we have kids is in that postpartum phase.
8:14 Dr. LaKeischa: Oh, yes. Oh, yes. And, and what’s so interesting about that postpartum phase is that it almost mimics what you’re going to go through with perimenopause and menopause. And I feel like if we could start having the conversations earlier and start connecting these dots is what I used to say. When I, when I was on a when I had my first podcast house call with Dr. Mack, I would say, hell, I’m helping you connect your health dots. And so I want us to be able to connect that.
I had my own postpartum story and it was after the birth of our first child, he was actually premature. And I was not prepared for the swing of hormones that happened to me because I had been in the hospital for a month. and been on bed rest because I actually went into preterm labor doing a C-section. And so I remember that day, well, that whole day I was in preterm labor and was trying to ignore it, right? But the contractions were different.
And I say that all the time. When I recall the story, I go, you know what? I knew those contractions were different because I had fibroids. I knew I had uterine fibroids. They were growing with the pregnancy. One of the features was that my fibroids were not inside the cavity, they were in the muscle. So that was a plus, but still irritated the uterine muscle. And so I was having Braxton Hicks all the time, but these were different.
And I remember talking to my mom earlier that day and she was like, how you doing? I was like, kind of contracting a little bit, but I’m just going to hang out in the call room. And so hanging out in the call room, I had to have a come-to-Jesus conversation with myself, so to speak, and say, don’t have a preterm baby in the call room down the hall from the NICU. Go say something to somebody.
But it wasn’t until, like I said, I had done the C-section, and I’m literally leaning over, kind of huffing and puffing. And the other doc is looking at me. He goes, what’s going on? I’m like, yeah, I need to go. and then get evaluated and the whole thing. And so I end up on bed rest for a month, right? Go through being put up in Trendelenburg where they put your feet up, have your head down, have medication on board, giving the baby medication to help his lungs to get developed quickly.
And even then he still came early, he came at 35 weeks. And when he came at 35 weeks, my milk supply hadn’t really come in fully. So I’m expected to pump and give this pretermer milk. And I’m stressing because I can’t produce. So the stress still impacts your milk letdown, which then I’m more stressed. So I’m in this cycle. He had to stay in the hospital. So I was not emotionally prepared. I knew intellectually, oh yeah, he’s about to stay. I’m going to go home. But I wasn’t prepared for that. Was not. And I remember when my doctor came and wrote my discharge and I’m just like, but wait, wait, I’m going home and he’s staying? Like, no. And so I remember sitting in the house and my mom is there, my mother-in-law’s there because they had been doing a tag team because I’d been on bedrest. The last two weeks of my bedrest, my doctor allowed me to go home if I had people there to make sure I was being compliant because you know, doctors are the worst patients, right?
And so, I had people around me, I had a community, but I felt so isolated. And I did not feel that anybody understood what I was going through. And the hormones were just, they were swinging from one side to the other. And I remember just sobbing in my closet one night, just like I’m ready for him to come home. I just wanted us to be this family I had put together in my imagination. And it wasn’t coming together. And so being deprived of sleep, my husband says, he recounts how I literally was delirious at one point. And he made me, he was like, Keisha, you have to go to sleep because you’re not making sense. Like your words are not even I don’t understand what you’re saying.
And I don’t even remember, but he was like, yeah, there was one point we all were just like, she’s not like you’re not coherent. So I wasn’t getting sleep. So again, so sleep is off, that happens in perimenopause, right? Your progesterone dives, that happens in perimenopause and menopause. You know, your estrogen goes down significantly because you don’t have that placenta around making that estriol, and you don’t have that.
So you see this mimicry happening, right? But nobody’s talking about it. You may not have the hot flashes, but sex drive is gone. You’re like, what? No. Okay. You may, I mean, if you’ve had a vaginal birth or if you’ve had a C-section, you’re healing. Nobody talks about that. Right. I remember them giving me I had, I had vaginal deliveries for both of my children. I remember, of course, with my son, they give me this peri bottle, right? It’s like, this is what you’re going to use.
Like, wait, OK, I know I’m an OBGYN and I’ve said all of this to all of my patients. But what am I supposed to do with this again? Yes. And it’s just this world that you feel isolated and you feel that you’re the only one going through this. You’re leaking from everywhere.
14:50 Dr. Ginger Garner: Oh gosh
14:41 Dr. LaKeischa: And your stomach is still looking four months pregnant. You’re like, wait, what just happened?
14:57 Dr. Ginger Garner: You’re leaking from everywhere and yet everything is dry.
15:00 Dr. LaKeischa: Yes. All at the same time. All at the same time. All at the same time. And so I remember going to my doctor. She was wonderful. And let’s say she was because she retired. She’s a retired OBGYN now, but Dr. Gaudette, lifesaver, lifesaver. She was actually a colleague in the hospital with me. And when I found out I was pregnant, I went to her and I said, would you be my doctor?
She was like, absolutely. Because as soon as I came in, bright eyed, new attending, she helped me out. She was there. And I remember going to her for my postpartum visit and just tears. And I was like, this is not me. I was like, what is what’s going on? And she was like, It’s, it’s postpartum. It’s some people call it baby blue. She’s like, now, you know, she’s like, I’m telling you every, all the textbook stuff, but now you’re experiencing it.
Yeah. You know, she’s like, we’re going to watch if it goes longer than four weeks, it’s now considered a textbook definition of postpartum depression. And if you need medication, it’s okay. And she gave me permission to feel what I felt and be where I was. And to have access to the tools that were available to me. [That’s huge.] It was a game changer. It was a game changer.
And then when I got pregnant with our second child, with our daughter, because of my history, I actually had to go on progesterone shots to make sure that I didn’t go into preterm labor. And that is where you have to start fighting with the insurance companies. So I get a letter from the insurance company after I’d started the injections at 16 weeks, because you wait until 16 weeks, they wait until second trimester. And I think I’d been on the shots for about two weeks, like, yeah, week 18. And they’re like, yeah, you don’t qualify for the injection. I said, whoa, whoa, whoa, whoa, whoa. What do you mean I do not qualify? And it was because of a ICD-10 code. Oh, goodness. That they were going to take the destiny of my child in their hands.
17:25 Dr. Ginger Garner: Over a code.
17:27 Dr. LaKeischa: So of course, I almost missed a week of injections because of the back and forth and the back and forth. And they ended up having to send the medication to my house because they sent it to my office before. And my MAs (Medical Assistant) would give me my shot, which funny story here.
So I would come in and I would get my shot on Wednesdays every week. And I would come in and my MA would give it to me first thing as soon as I walked in the door. By 10 o’clock, I would be sitting in my chair, zonked out, just completely like, oh my gosh. And then one day she came in and said, Doc, we’re giving you that shot in the morning. What does progesterone do for you? Doesn’t it make you drowsy? Isn’t it supposed to help you sleep?
I said, oh my gosh. You know, when you’re the patient, sometimes you just, I would just want it to get in. I was like, I don’t want to forget it. I want to make sure we do it. She was like, so what we’re going to do, we’re going to give it to you in the evening after your last patient, and you’re going to go directly home. You’re not going to stop at the store. You’re going to go directly home. So that was one thing.
But when they sent it to my house, my husband had to give me my shot one week. That was hilarious. And he’s in the lab. He’s a laboratory scientist. And he does phlebotomy. But when you have to give your loved one medication and an injection, and it’s a thick preparation. And all I remember him saying is, oh my gosh, this is so thick. I was like, just hurry up. Just put it in. Just get it.
And so I’ve had to be on both sides. I’ve been the physician where I’ve been had to fill out the paperwork and fight with the companies and say, no, this is my recommendation. This is why I’m recommending it and have to explain why I’m practicing medicine the way I’m practicing it.
And then I’ve been on the side where I am the patient and I’ve had to fight with the companies and have my doctors say, nope, you got to fill this out again because I can’t fill it out for myself and all of that. And I’ve been on the side of receiving medical care that has not been the best because they didn’t know who I was. And I said, that does not matter. It does not matter.
And I think I was sharing with you the story of when my first pregnancy was the epidural, was the anesthesiologist that was giving me an epidural. And I was trying to tell them, something’s not right. You’re in the wrong space. Like I feel something. No, no, no, no, no. And arguing with me of what I was feeling. What was going on in my body. And then when they went to change out the tray, they were alerted of who I was and then proceeded to come in and fuss at the nurse for not letting them know who I was. It does not matter. Yeah.
20:26 Dr. Ginger Garner: You’ve just, you’ve put your, you have perfectly encapsulated in your incredibly important story, how the system is broken, right, from both sides. If you’re a woman, you’ve pretty much experienced gaslighting. [Oh, absolutely.] Pretty much. And if you’re a woman of color, then it’s leaves me speechless because it is guaranteed, it is guaranteed to happen.
And so, you know, in our discussion today, I’m so excited about it because we are sharing, you know, with you, you’re sharing your story about, um, how everyone listening can become impaired, empowered because your story is empowering. Your story gives life and validation to say that this happened to me, and I am in the system, at the highest levels of the system. I’m in it, and it still happens to me.
And so it’s not to scare people, it’s to say, here’s the information you need to take in. that when you’re experiencing these postmenopausal issues where everything from, you know, vaginal dryness, which may not seem like a big deal until maybe you want to actually, try to have intercourse, you know, then it’s painful.
And you don’t feel like yourself and you’re having all of the symptoms of that low estrogen and low progesterone that, that you can say, Is this actually perimenopause or am I just postmenopausal? And so when we talk about that experience, you know, it kind of pushes us into the perimenopausal conversation because when perimenopause shows up, she does not call before she shows up. She does not text. No. Not even a text
22:27 Dr. LaKeischa:. She’s not invited. She’s a very rude guest, I must say.
22:32 Dr. Ginger Garner: She just shows up. And one of the things you said is not having to white knuckle it through perimenopause. And so now it’s like, OK, how can we empower women and people who care about women to help them? Know what clues they need to really tap into. We’ve mentioned a few like, you know, painful intercourse, vaginal dryness, the mood issue, not sleeping well.
So what clues what are the some more clues that they need to be seen? And who really should they see? Because there’s an array of people that in all levels of medical education, So you going to medical school. Most PT schools are located inside medical schools, whatever kind of education you’re getting. Right. I got zero education on pelvic health. Zero education on menopause. Zero education on endocrinology and everything that I know is postdoctoral training.
23:31 Dr. LaKeischa: Pretty much. Absolutely. And I’m validating you and saying, saying like ditto over here, what I. experienced in terms of education is in OBGYN, we are trained to take care of women who are pregnant. Basically, we are taught to take care of the obstetrical, we are taught very rigorously obstetrical care.
The gynecological care is a, there’s the well woman exam, you know, you can give some counseling. If you feel that you want to give prenatal counseling and that becomes part of your practice, great for you. There’s really no track that says, here’s what we do with prenatal counseling.
How do you help a woman understand what to do before she gets pregnant, which is part of that GYN care. We are taught about pap smears, abnormal pap smears. We’re taught about contraception, how to have that conversation. We are taught about how to do surgery. And then if you want to do something, what we call subspecialty, that is the fertility side, that is reproductive endocrinology. That is in addition to your four years of OBGYN training, you then do another, I believe it’s three years of reproductive endocrinology. And that is just with the fertility side.
If you want to go into another subspecialty called GYN oncology, that is another three years outside of your OBGYN specialty. And those are mainly people that will do a lot of surgery and of course treat oncology patients.
If you want to go into a specialty of OBGYN, that is your MFM, maternal fetal medicine.
So out of all of that, have you heard perimenopause, menopause specialist? And women will spend a third of their lives in menopause. We are told you need to be seen less when you actually need to be seen more, because your body is changing so rapidly and the physiology is changing.
And what has happened is I had a very good conversation with Dr. Carrie Jones the other day, and she enlightened me in the fact that what happened is a lot of the studies that we look at for like cardiovascular disease and a lot of those big studies around the big morbidity and mortality issues that happened to people were done on men. And they excluded women because of our cycles. It was because of our cycle because they were like well we’re not sure how to do the confounding factors around that. And it’s because of our cycles that we’re so unique that we really need to be studied more.
And we need to understand how these hormones at the various levels really are protective. How they help with your body’s functioning. So some of the symptoms that we have just kind of chalked up to, oh, you’re getting old, in my opinion, are because your hormones have changed and now you’re in perimenopause and going into menopause.
So for instance, that brain fog, where everybody’s like, oh yeah, you’re gonna forget a couple of numbers. You’re gonna forget why you walked in a room. You’re gonna walk in and go, why was I here again? Huh, ah, sure. Or not being able to string your words together as fluently as you used to, or feeling that, you know, you can’t retain information as you used to when you’re reading.
And since here, you start stuttering a little bit, right? And so you start wondering about, oh, am I going into early dementia? I mean, what is going on? And we really need to be able to say, okay, here are some of the things that will happen there. What we’re finding is that there are over a hundred different symptoms of perimenopause and menopause.
27:40 Dr. Ginger Garner: Yeah. I think that’s important to emphasize because too many of them are blamed on age or just, yeah.
27:48 Dr. LaKeischa: Yes. Itchy skin. Oh my gosh. One of the new ones that I’m having at confessions here, you know, I’m coming to the altar, right? Is phantom smell. Oh my gosh like i’m starting to have this superpower of smell that is ridiculous
27:40 Dr. Ginger Garner: Kinda like what happens in pregnancy too
27:48 Dr. LaKeischa: Exactly. Exactly. And so our cleaning solutions, we’re having to figure out which ones we once that’s over we’re not buying that one anymore. What are we changing out. Body odor, you know, starts changing. I’m like, okay, are you what what’s going and everybody around is like, no, you don’t smell different. But to me, I’m smelling something that is different. Yeah, you know, your eyesight is changing. You know, all this itchy skin, itchy ears.
The joints hurting, that inflammatory process that’s not protected anymore or actually kept at bay because we know that testosterone and progesterone have anti-inflammatory properties. They calm down our immune system and don’t make, let it get too ramped up.
So my answer to your question, because I know we just threw out a whole lot, right? Is if you are experiencing something that is different in your body and it is interrupting your life. And you have gone to your healthcare people that are part of your healthcare team that you have put together so far, be it your GYN, your OBGYN, your internal medicine, your family practice doctor, whoever is part of your team, I say your healthcare team, and they have done what is in their toolkit to do for you. And they’re telling you, I cannot find anything that I can put a name and an ICD-10 code to.
Then it is time for you to possibly start looking at people that have functional medicine as part of their practice, integrative doctors as part of their practice, because that means that they will have different tools that they can utilize to test, to ask different questions, to start probing and seeing if we can really get to the root of the problem.
30:22 Dr. Ginger Garner: Yeah, absolutely. Functional medicine, integrative medicine, lifestyle medicine, are all things that can really ground you and your hormonal balance. Not just figuratively, but the labs, you know, don’t lie. And we can see these numbers. I had someone, um, send me a query to our website over the weekend because she had just gone to her physical visit.
It was with her OBGYN. Who had said, she had asked the same question. She’s like, I’m not feeling great. I’ve got some joint pain. I’ve got some pelvic pain. Um, would testing or, you know, hormone replacement help. And this particular practitioner. Don’t even know who it is, but it’s kind of a canned response you hear often is, well, testing is expensive and hormone replacement may not do anything. So let’s just, you know, not waste our time with that. And just like that. The conversation was over.
31:27 Dr. LaKeischa: If I had a nickel for every time that you or I’ve heard that. That type of a response, I either hear that, that somebody has told them, Oh, it’s too expensive. Don’t even worry about it. Or I’ve heard you’re too young. We shouldn’t even think about that right now.
31:48 Dr. Ginger Garner: And I’ve also heard you’re too old.
31:51 Dr. LaKeischa: You can’t do anything about it now. Yeah. So we are banishing women to a figurative symptomatic error or area in life and just said, hey, you just go figure that out.
32:09 Dr. Ginger Garner: It’s some kind of awful purgatory or something.
33:12 Dr. LaKeischa: Yes. Yes. Yes. Exactly. That’s exactly what I call it. I call it purgatory. I’m like, why? So, so because I do not have, when I say I, a practitioner, you come in and because I’ve looked at my limited tools and I cannot give you an answer from this amount, this little stack of tools. I say to women, then ask them, hey, do you have somebody you can refer me to?
And I say this all the time. If I’ve come to the end of what I can do for you, I will say, look, I’m not going to waste your time anymore. Or I’ll say, hey, do you mind if I go consult a colleague? Can I talk about you to another colleague? Can I give your case over to someone? Can I kick this around a little longer?
33:02 Dr. Ginger Garner: That’s probably one of the most important things that you can hear. In a time where we’re on the verge of women finally getting the care that they need because there’s so many practitioners without the training right now. Is to hear someone say, I’m not sure, but let me check this out.
33:20 Dr. LaKeischa: Exactly. And going back to and finishing up that question that you asked about training. Training is really on the practitioner. So you’re right. So I said, I said all that stuff back in the beginning about what I got trained in OBGYN world. And what I do now with perimenopausal and menopausal women is what I have done on my own after practicing for, I think it was 10 years or so. In the traditional world of OBGYN and feeling like there’s something more here. There’s got to be more.
And starting to dig myself and find this institute or find this CME, find this lecture over here. And so there is this little kernel that’s starting to pop. That is functional medicine, that is integrative medicine, that has within their women’s health and talking about hormones, talking about how when your body changes. These are some things, here are some options of what you can do. Here are some tests that may not be the test of you going to your lab and getting your blood drawn, but there may be some other things we can look at because you are an entire organism. And we need to look at other than just one component of you.
34:43 Dr. Ginger Garner: Yes. Yeah, absolutely. That brings up a really important question because,, I get this a lot with women who are in practice who come into my practice. They are, they can be across the range, but let’s start with postpartum since we started there and postpartum, that’s where it all begins. You know, anyway, as during those years, where they come in and they were working on a particular pelvic pain, maybe they had tearing, maybe they have a split of the abdominals, a diastasis, you know, rectus abdominis, or a C-section scar. And we’re working on all those things that’s combined with maybe some pelvic heaviness or prolapse type, you know, symptoms.
And they’ll say, well, you know, eventually I want to have another baby, but that’s not happening if I can’t have intercourse, right? [Right, right.] And then we start talking about, well, you know, are you still breastfeeding? You know, what’s happening? What else is going on? Should we actually test levels and then make that referral? Because you might need some kind of replacement or adjunct at this point to kind of get you through.
So what would that look like for them, right? I know what it looks like for me, you know, sometimes we’ll test that and then I’ll make a referral and, you know, kind of get them going on their way. But I think too many women think on postpartum, I don’t, I shouldn’t need anything. I have all my hormones, right?
36:10 Dr. LaKeischa: Oh my gosh, that is such a great question. And I did not have the opportunity to really treat postpartum women the way I can treat them now when I was in my traditional practice. Because back then, one, I didn’t have the knowledge base that I have now. But back then, I only had birth control pills. I only had, okay, so I know I see you 12 weeks, I say that you’re okay. It takes longer than 12 weeks to heal. Let’s just all be just, let’s just say what it is. Right.
And I have one person in particular that I remember who gave birth. I remember literally right after she had the baby and phase four, which was, you know, placenta was, was delivered. And she was just like, oh my gosh, she was euphoric. Like I’d never seen this type of euphoria. And she was like, oh, I can’t wait. And just loving on her husband. And I can’t wait for us to have another one. And I’m like, girl, I’m still stitching you up. Like, whoa. Like, wow. Okay.
She came in my office for her four week postpartum visit, her first check-in. And I did not recognize her. She was so depressed. Her levels had bottomed out so bad. And I was, it actually scared me as a woman because I really did not recognize who she was. Like I just could not, like her soul was different. And I just sat with her and she was like, I don’t know what’s wrong with me
She was like, I don’t want to touch the baby anymore. She says, he’ll be crying in his bassinet. And if it weren’t for my mother-in-law, I think her mother-in-law, one of the mothers was there and her husband, I would just walk past his bassinet. She says, there are days I just wanna walk past his bassinet, pick up my keys and get in the car and drive. And I was like, whoa. And this is where I’d started reading and start. I says, okay, I think you need some estrogen. And she was like, what? I was like, yeah, you need some estradiol. And I literally treated her like a post, like a perimenopausal woman.
And I said, I want to see you back in six weeks. I want to see you, you know, so I kept tabs on, I was like, I need to see you a little more often. And that estradiol brought her mood back up. She was like, what was that? She was like, what? I said, you literally bottomed, like, I don’t know if when you have a delivery, you have a tremendous blood loss, vaginal or C-section, and that can affect your pituitary gland.
And your pituitary gland sends signals to all of your organ systems because it’s kind of like one of, I call it the conductor of the orchestra. Your hypothalamus creates the music, it composes, and then it sends it down to the pituitary and the pituitary says, okay, I want the ovaries to do this. I want the thyroid to do this. I want the adrenals to do this. And if everybody is doing what they’re doing, we’re playing a beautiful symphony, right?
Now, when you have tremendous blood loss, the pituitary, those signals can’t get to those organ systems. So I think for her, that may have been, I’m just kind of extrapolating back. And so when you give somebody the end product that they need, instead of sometimes going upstream is what we say and giving them the products to help them make, it actually helps them a little bit to feel better a little faster.
39:57 Dr. Ginger Garner: Yeah.
39:58 Dr. LaKeischa: Okay. So giving women tools, giving them options, helping them understand these are the various different options that you have is so, so empowering. It’s so empowering. And that’s what we have to do now in this perimenopausal menopausal state is to say to women, You don’t have to sit here. You don’t just have to grow old gracefully. There are tools that you can use that can help your body to function the way you want your body to function.
40:47 Dr. Ginger Garner: Yes. Yeah. And having that knowledge is, you could use the word validating, but it is so far beyond validating because we haven’t had that to date in history. So it’s a big deal.
41:03 Dr. LaKeischa: Absolutely. Absolutely. And I think, sorry, I know I went around the mulberry bush, but you were asking like, what can, what can women do? So when you have a person that has come to you and you’re doing a workup for them, is that what I remember you were saying? Like with, um, postpartum.
41:25 Dr. Ginger Garner: Yeah, it was, you know, it’s just really to, you know, let women know that sometimes you’re going to need that support hormone support postpartum. Yes, yes, yes. It won’t just reset sometimes.
41:47 Dr. LaKeischa: You won’t just bounce back. And I feel that that is the narrative, unspoken narrative that happens when you’re going through your OB phase. Like when you’re going and it’s like, oh yeah, so your body’s changing because you have a human inside of you. You’re like, oh yeah, that, yep, that’s normal. That’s normal. Your feet hurt or this hurt or your pelvis hurts. Your ligaments are stretching and all.
And so we tell you, yes, just get past this. If you just get to this side, everything is going to go back to normal. And you know what, Dr. Ginger? I feel that that is the same prevailing thought when it comes to perimenopause and menopause. We tell women, if you just get through this, everything will go back to normal. And that’s why I actually have stopped using the term postmenopausal. Because I found that women that said, oh, I’m postmenopausal, I’m done with that. I was like, what are you done with?
What exactly are you done with? And some of them will say, well, I don’t have hot flashes anymore, or I never went through menopause. Now that’s the one I love. I never went through menopause. Well, what do you mean you never went through menopause? I never had the hot flashes or the night sweats, so I never had that. So I never went through that. I was the lucky one.
Okay, let’s, this is where education comes in. Menopause is 12 consecutive months, no period. Textbooks say once you do that, yes, you’re technically postmenopausal, but you’re not going back to anything. Your body’s not going back anywhere. Yeah. And I think this is where women get frustrated because now they’re like, well, why can’t I do what I used to do and get the five pounds off because I have that gala that I’m going to or we have friends that we’re going out. Or why can’t I drink that two glasses of wine at dinner and bounce back the next day? Why is it that I can’t eat what I used to eat or why can’t I do what I used to do and get my body to react the way it used to react? Because it’s different.
43:45 Dr. Ginger Garner: Yeah. I say the same thing to new moms about postpartum. And some of them are moms that their kids are 20 or 30 years old. I’ll tell them, well, once you’re postpartum, you’re always postpartum. Especially until you work the issues out, you know?
44:04 Dr. LaKeischa: I love that. Yes, absolutely. Absolutely. I wish I had known and really had a true understanding of pelvic floor physical therapy before I had my kids. I had a inkling of it because one of the rotations in our residency. The urogynecologist, sorry, that’s another subspecialty. Urogynecologist that I went and was able to rotate through, she had a pelvic floor physical therapist part of her practice. And that was the first time I’d ever heard about it.
And she was like, oh yes, I actually incorporate pelvic floor physical therapists for my patients. And she’s like, I’m finding it works really well. And I was like, okay, that stuck back here, right? So years now later, I’m finding you, I’m finding other pelvic floor physical therapists on social media, and I’m watching what you guys do. And I was like, oh my gosh, if I had had that when I had my myomectomy. If I had had that information when I had the vaginal deliveries, you know, wow.
Now I do understand more of the connectivity with my core muscles and using and doing things like Pilates and yoga and breath work and how that really supports. So I’m able to really benefit as a perimenopausal woman now. Going, oh, that’s it. And I have stopped really recommending the Kegels. I was like, no, that’s not it. I was like, you need to do some breath work.
Yeah, you need to do some breath, you need to do some deep breath. And then it comes into that whole mind body connection, right? And this is where we start talking about that whole person, and how a lot of us are going around holding our breath every day and our shoulders are up like this all day long. And how you and I said right before we needed to take that breath. Right.
You know, because we had talked about all the running and the this and the that, and we both felt it. We felt like, ooh. And we’re like, no, we need to be grounded for this conversation. We need to bring the energy here. We need to both be present. Take a breath. Let that belly go. Let that diaphragm deepen. Do all that needs to be done and and support this being. And be here. Yeah.
46:38 Dr. Ginger Garner: One of the most profound things that I see is usually what I hear when someone’s speaking. It’s how much their voice tells me about pelvic floor health. Yeah, because it’s mucous membranes.
46:55 Dr. LaKeischa: Amazing. Oh my gosh, you just triggered a thought. I love going to do magnesium floats. And I have noticed after being in the float for an hour, my voice has dropped an octave.
47:13 Dr. LaKeischa: Oh, wow. Wow.
47:17 Dr. LaKeischa: Literally when I come out and I, cause I’ve done a live before and I’ve done a lot or I’ll call my husband or someone and he’s like, you’re good now, right? My family will even be like, isn’t it time for you to go do that float thing? Cause you a little, a little up there. I notice going there, literally your vocal cords stretch out, your breathing is different, and you’re right.
47:48 Dr. Ginger Garner: What I do is I measure it with ultrasound imaging. Yeah.
47:56 Dr. LaKeischa: You got to teach me something.
47:58 Dr. Ginger Garner: Yeah. So in practice, I’ll use a trans abdominal. Sometimes I’ll do transperineal, which means for those of you who don’t know, transabdominal, transperineal. Transabdominal is just through the abdominal wall. It’s not invasive. And transperineal is usually kind of beside the labia or sometimes at the labia. It’s not internal, so not transvaginal. And then I’ll have them do different voicing tasks and different breathing tasks. And then I can see how it’s impacting both the respiratory diaphragm, the abdominal wall, and the pelvic floor.
48:31 Dr. LaKeischa: Okay, so you’re about to get into, you’re about to take me into my geeky world of energy work too. Because if you think about the area of the throat and that throat chakra, and being able to have your voice and us giving women their voices back. That connection with what’s going on in our pelvis.
I have a lot of women that when they talk about their cycles or they have fibroids, I’ll ask them, what brings you joy? Are you living in your creative space? And this is where I love doing what I do now because I have the time to explore the whole person with my patients now.
49:40 Dr. Ginger Garner: Yeah, because that’s important. Yeah. And that’s why I think that, you know, when you talk about menopause too, if you think about how estrogen affects the vaginal tissue, for example. It’s going to affect the vocal cords in the same way. And so I ended up working with women and men who go through their voiceover actors, or they’re performing artists.
And they’re losing not just pelvic function but they’re also losing the ability to sustain the phrase. To be able to project their voice. Which also is true to support that right to support the core, support the pelvic floor, and when i go and measure and i’ll have them do all these different tasks they’re unable to do it, because they’ve either got a paradoxical pelvic floor.
Or literally the pelvic floor becomes unplugged from the core they’re too uncoordinated anymore and so you begin to see that or they have prolapse symptoms where they feel that pain or heaviness in the pelvic floor, maybe during a cycle, maybe, you know, around menopause. And it can all be sometimes related to shifting the way they speak, shifting the way they are breathing. And then sometimes, often, it’s that hormonal support as well, whether it’s through lifestyle medicine or through HRT, to be able to like get their whole power back. Their voice, voice to their pelvic floor to just reclaim that power.
51:08 Dr. LaKeischa: Wow. Thank you. I learned this, this, this conversation went two ways today. It really did. I love it. I love it. That makes so much sense to me. It makes a lot of sense. And, and it, it makes a lot of sense in that perimenopausal menopausal phase of life. When women feel that their ability to take care of themselves, to seek the right help has been taken away.
51:36 Dr. Ginger Garner: Yeah. Yeah. And this is where not feeling listened to and not feeling like you have a voice. And women are always taught to be small and don’t make waves. And so when you’re literally losing your voice and your continence at the same time, it’s devastating. Yeah.
51:57 Dr. LaKeischa: Wow. Wow, wow, wow, wow. I love this point that we came up to.
52:05 Dr. Ginger Garner: Yeah. I have one more question. Absolutely. My question, because I’m thinking about the, you know, the holistic person. You brought in the concept of the chakras and yoga and that was a primary way that I practiced ortho and pelvic PT for, gosh, it’s been nearly 28 years now. And so I think the concept of feeling heard, feeling seen, feeling like someone’s not just treating your, you know, vaginal dryness. That they see you as a whole person, and they care about you thriving in life, brings up a question that I think we’re going to get more and more often.
And I think the answer will be it depends. But I also think you have a great deal of wisdom on this is as women come into replacement therapy, because it is very prescriptive and individualized, right? It’s what you’re doing every day. It’s a complex layered science that requires looking at a lot of variables. What do you say to women who are either, they are peri, they’re not peri, they’re menopausal, or maybe they’re postmenopausal, and then they’ve got these big three things, right? Heart disease, maybe it’s osteopenia, osteoporosis. They’re concerned about breast cancer. These are the three big morbidity, mortality issues that impact all of us as women. Do those women start HRT? Do they stay on it forever? What do you, what do you see as happening, you know, as we move through menopause and get to the kind of the other side?
53:50 Dr. LaKeischa: That is a great question, because I feel that what is going to happen is that HRT therapy or BHRT therapy is going to, first of all, we know it is individualized. It’s very personalized in terms of dosing, in terms of the delivery system. What’s going to also become very personalized is the duration. So we do know that it is recommended that women start their therapy within five years of going into menopause.
And I also say, start seeing somebody when you’re in perimenopause. I mean, this is where you can start getting your progesterone back up. You can even have some type of testosterone if need be, you know, maybe even some supplements that help you produce those end products, you know, to be able to make sure that you’re supported that way.
The conversation comes when you’ve been on therapy for about 10 years. And then it’s like, okay, do I continue on this? I’m now 65. I’m now approaching 70. Do I stay on this? And that’s where the individualized conversations come in. Because depending on how active you are, what’s going on in your life, and the follow-up, because we have not found to date with the studies on BHRT any adverse reactions to that bioidentical hormone therapy.
We are seeing the positives. So we are seeing the protection from cardiovascular. We’re seeing the protection from osteopenia and further osteoporosis. We’re actually seeing that testosterone can be protected from certain types of breast cancer. And so this is where I think it’s going to be one of those tools that you have to keep evaluating with your practitioner on the validity of it in your life at that time.
55:56 Dr. Ginger Garner: So thank you so much for that response, because I think that, and I get this question a lot, too, in practice. Is the hows and the whens and the whys and the wheres, and how often do we test it? And, you know, the labs cost, you know, X number. [Right, right.] They want to do pellets, or they want to do a patch or oral progesterone at night. And then all of a sudden, it gets very overwhelming. Yes, yes, yeah, overwhelming.
And hopefully, what we’ll see is that cost might then come down as things become more directly available and there’s industry disruption like there has been in so many other ways where it’s more available to consumers, to women. So I think that is a really important point to finish on is that a good practitioner is going to be very individualized in the way they look at HRT prescription for you and other lifestyle changes.
56:55 Dr. LaKeischa: Absolutely. Absolutely.
56:58 Dr. Ginger Garner: And that a blanket prescription, although would be nice as kind of a pie in the sky. There’s no rubber stamping and cookbook recipe here for that. No, no. Because you have to look at glucose levels, you have to look at gut health. [Yes, yes, yes.] Immune function. Yes, yes. Yeah, in order to say, gosh, what are they going to tolerate?
57:27 Dr. LaKeischa: Absolutely, absolutely. You’ve hit the nail on the head.
57:31 Dr. Ginger Garner: Oh my gosh. This has been such an informative, uplifting, empowering conversation again.
57:40 Dr. LaKeischa: Thank you. Thank you.
57:41 Dr. Ginger Garner: So yeah, I just want to thank you so much for taking this time. Tell everyone again, where you can be found. I know you’re on Instagram. Yes, I know that. Oh, and shout out to Dr. Carrie Jones, because I think I forgot to say that during the podcast. So I had saw I had seen a webinar that you’re doing on progesterone. One of my favorite topics. So yeah, tell everybody again where they can find you if they want to work with you where they can learn more from you.
58:10 Dr. LaKeischa: Absolutely. Thank you so much. I am on all social media platforms at Dr. LaKeishaMD. That’s D-R-L-A-K-E-I-S-C-H-A-M-D. And you can schedule a consult visit with me at talkhormones.com. Go to talkhormones.com and schedule a consult and let’s see how we can work together. Even if you don’t live in my general area, there are things that I can do for you and help you to be able to start navigating this new world. I call it, I’ve coined the phrase, the other PMS, your perimenopause menopause survival.
58:46 Dr. Ginger Garner: Yeah, I love it. Thank you so much, Dr. Lakeisha for joining me again today. And you guys watch out for her work and all the awesome things that she is doing because it is saving women’s lives left and right.
59:01 Dr. LaKeischa: Thank you. Yeah.
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