In this episode with Dr. LaKeischa, MD, a functional medicine ob/gyn, we are taking on the myths of menopause. We uncover the truth of navigating menopause, so you can find help and guidance during this inevitable phase of your life.
Here are a few of the main myths of menopause that we talk about in this podcast episode:
Because the reality is that there are many supplements, bio-identical hormone options, and lifestyle changes that can dramatically, if not completely, ease your symptoms of menopause. And these symptoms can include all sorts of things like brain fog, musculoskeletal pain, hot flashes, anxiety, and trouble sleeping (to name a few).
Every woman will go through this transition of menopause, and it doesn’t have to be a terrible experience. Busting the myths of menopause will help you find more peace and ease during this inevitable change. It’s just a matter of finding guidance from someone who understands, listens, and knows how to support your body during the phases of menopause and perimenopause.
Watch or listen to Dr. LaKeischa and I talk about some ways to actually thrive in menopause.
Also, if you have enjoyed listening to this podcast. Please consider leaving us a 5 star review wherever you listen to podcasts. This helps more listeners find us and learn this incredibly valuable information. Thank you for listening!
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, everyone, and welcome back. I am here today with a fantastic, fabulous, wonderful, amazing guest. Dr. LaKeischa, welcome.
0:12 Dr. LaKeischa: Thank you. Thank you so much for having me today, Dr. Ginger. I really appreciate it.
0:16 Dr. Ginger Garner: I am really excited that you’re here on multiple levels. And y’all, I just before I go into my brag mode where I’m going to read her bio and tell you just how awesome she is, because you have to hear it. I just want to say I am excited to be talking to you on multiple levels. And we’ll get into that in just a minute on why, because before we press record, y’all, we got into all kinds of the stats on maternal fetal medicine and the outcome of how moms are doing and how women are doing and how women of color are doing.
And we have, we have thoughts and Dr. LaKeischa particularly has thoughts. And so I want to give her this platform to be able to do that. But you guys need to know first how great she is. Dr. LaKeischa MacMillan is an OBGYN. And her mission is to empower women for generations as they age, which is super important. To feel confident in knowing how to balance their hormones and how essential balancing your hormones are to healthy living.
Dr. LaKeischa graduated cum laude from Oakwood College, now Oakwood University in Huntsville, Alabama with a BS in biology, and then earned her MD at Loma Linda University School of Medicine. Now, in addition to her clinical practice, I’ve caught her doing awesome things like webinars on progesterone, which was like, when I saw your webinar came up, I was like, oh, I’ve got to listen to that. I need to learn more about progesterone.
You’re also a speaker and writer on women’s health topics. You contribute to several online and print publications, you’re just totally committed to making sure that women get the information resources that we need because particularly, and I think we should kick it off with this, the recent perspective paper that came out and the Menopause Society Journal and all the things swirling around menopause, because that impacts 100% of us. And so I think that might be a good place to start. Yeah.
2:22 Dr. LaKeischa: Yes, yes. Oh my gosh. Thank you so much for actually holding space for me to be part of your community today. I really do not take this lightly. Whenever I’m able to open up and have a voice and talk about women’s health, especially in this phase of life where it’s perimenopause and menopause. And yes, I bring with me my background of OBGYN, because I’m never going to leave the OB side of it. You know, as a woman, as a mother, as a practitioner, I have learned, though, that you change and you grow.
And so I’m part of the cohort now. I’m part of that. And so I probably, you know, have a little more stock over here, you know. But it is really interesting that women, about 6,000 women are going to go into menopause every day. That’s what the stat breaks down to. And you’re going to spend a third of your life in this phase. And yet, we do not give women any tools, support, guidance of what to do with this new body, this newness, this new phase.
But we will give you the talk before you go into adolescence. We’ll give you the talk before you have your first period. But what about the talk when your period starts changing? What about the talk 2.0 when you stop having your period and you still have so much life left to live? And this is my passion. I say this is the hill I am going to die on. This is where I believe I am here for this point in time, in this space, because we really need to understand what is happening to our bodies, give each other tools, talk about it, shine the light on it, so that we take the boogeyman away from it.
4:27 Dr. Ginger Garner: Yes. Yes. I’m like two hands in here to testify. Yes. So important because when we look back at when you, for those of you who, and maybe we’ll put the link to this paper, I know we’re talking directly to every woman and every person that cares about someone going through menopause, but you know what? There are many nerds among us. And maybe you want to just read that perspective paper that came out. So we’ll put the link to that into the, into the show notes for you guys. But the gist of that is what happened is an entire generation of women missed out on having the care that they need. Absolutely. Expand on that a little bit.
5:07 Dr. LaKeischa: So I feel I have a special place in connection with that, that a generation missed out. Because the WHI [Women’s Health Initiative] study, the hormone arm of that study came out my very first year of internship. Fresh new MD on my little chest so excited started residency July 1. All residency programs mainly start July 1. There’s some that start in June but July one is usually our fiscal year.
And about two weeks into residency, our program director comes into Morning Report waving this paper and she’s like, this was FedEx to my home. Oh my goodness gracious. We have to stop them. We have to stop it all. And we’re just like, what just happened? And this is where they started talking about how there were these bad outcomes, there was an increased risk, a perceived increased risk in breast cancer, there were endpoints that were coming out that were not part of the original study that they thought they were going to see.
And so we had women coming into the clinic saying, take me off of this stuff because you had epidemiologists going on national TV, just saying a whole bunch of numbers and they were well-intentioned, it’s just the translation didn’t happen. So you now have a lot of people confused. Don’t know how does this translate into the wild?
Because this study looked at, it had 40, clinics that participated in the study, about 166,000 women, but the average age was 63 years and above. And what they were trying to do was see if they could prevent a secondary outcome of a cardiovascular event in women that had had a cardiovascular event.
Because the knowledge was women’s increased risk for heart attacks, strokes, cardiovascular disease incidences were going up as we were aging. And they were trying to prevent that and saying, okay, what is it that could possibly do it? And they said, hey, maybe it’s the estrogen levels and the progesterone levels that women have over men. Maybe that’s it. So let’s give them some of that.
Well, they were giving us synthetic hormones. They were giving us hormones from horse’s urine, ladies. Conjugated equine estrogen and progestins. These are synthetic hormones. And what happened is that you saw an increased risk in a secondary event. You had this number that floated around about a breast cancer increase. And what has happened is those of us, so you have to think about this, your doctors that were shiny eye, bushy tail, just out of rest, out of school, were told hormones are bad, hormones are bad, hormones are bad.
And over this 20 year mark now, we are the ones that have been treating you and we have not necessarily taken the time or been given the time because we’re so sick, so busy in the clinic, seeing somebody every 5, 10, 15 minutes, to go and dig into the research about bioidenticals. What does this mean? There are different forms of hormones. How does this look?
And so what we have found is that women’s health has never fully recovered. And the option of bioidentical hormone therapy has never fully recovered from that hit back in 2002. And I say, think about it. It’s because we were the kids. We were the kids that got the notice, hormones are bad. And so now we have been treating you for 20 years and it’s never fully recovered.
9:01 Dr. Ginger Garner: So, now we’re beginning to set the record straight.
9:06 Dr. LaKeischa: Absolutely. You saw the New York Times article that women have been lied about, about menopause that came out in the summer. And I was like, yes, finally, we’re talking about this.
9:21 Dr. Ginger Garner: Yeah. Um, so now in, in kind of setting that record straight, things are finally beginning to even out, but it also leaves women with a massive question mark. Right now, what do we do? I wasn’t given them. Can I start them now? Does it increase risk? Can I start them if I’m 10 years, 20 years past?
What happens when osteopenia and osteoporosis come into the mix? How long do women wait before they you know begin to start HRT [Hormone Replacement Therapy], all of that. So it is leading to you know more questions, but i think the most important thing is that now we realize that we have to urgently do something to right the ship to decrease this risk of health issues that is impending like right now.
10:08 Dr. LaKeischa: Exactly, exactly. You have hit the nail on the head. Now we really have to play catch up. And we have to do this very quickly. Because the number one risk of morbidity and mortality in women is heart disease. That’s number one. number two is osteoporosis, and number three is breast cancer.
And what we know is that these hormones can actually decrease your risk for cardiovascular disease, can decrease your risk for osteoporosis, and there are some forms of bioidentical hormones that can literally decrease certain types of breast cancer. And so we know that bioidentical hormone replacement therapy as a tool, not a blanket statement, and I say that all the time. It’s one of the tools that can be offered to you. And so now, like you’re saying, we need to get out there and say, hey, like NAMS [North Americam Menopause Society] said, within five years of going into menopause, you really should be on some form. Gold standard is our bioidentical hormones.
I’m going to go a step further and say, when you’re in perimenopause, you can actually start that now because there are some forms of hormones and looking at your hormone levels that could really be beneficial to you. And I think that is where the conversation needs to open up even more is to include this perimenopausal phase that can be five, seven, 10, 12, 15 years, ladies, before you go into full-blown menopause. I know, it’s purgatory. I’m sorry.
11:45 Dr. Ginger Garner: I hear the collective groan. Groan no more.
11:48 Dr. LaKeischa: Right. And there are various different symptoms. Everybody’s going to have a set of symptoms that look different. And that is one of the things that is baffling, I believe, to the medical community that has not been able to draw a big, like, oh yes, let’s do something about these symptoms.
Because I feel in my opinion, these symptoms have been brushed off as, oh, you’re just getting old. Oh, you’re just growing old. Or what’s wrong with you? It’s all in your imagination. No, it’s not. There is physiology that is happening, biochemistry, and it is showing up as a symptom for you.
12:30 Dr. Ginger Garner: Yes. Yeah, that is such an important point to make. So to, you know, everyone listening, if you are experiencing these perimenopausal symptoms and we’ll launch into, you know, there’s a litany of them, but we can overview a few of them. And you are getting that brush off because honestly, I do 100% believe that’s what’s happening because when people come into my pelvic PT practice. They’ve already been brushed off.
And usually it’s, well, I don’t know what to do. It’s age or whatever. Or just go see the pelvic PT and they’ll do something. Just, they’ll do something with you, you know. And so they walk in and nothing’s been tested. We don’t know what any levels are. And they’re experiencing a multitude of musculoskeletal symptoms that all end up landing kind of in the pelvic girdle and even low back and all of these areas.
13:21 Dr. LaKeischa: All of those areas, all of those areas. Oh my goodness you’ve said it, you know, you get people, unfortunately, that come to their doctor first and are looking for some guidance looking for someone to say, It’s not in your head. It’s not made up. You’re not imagining this. And sometimes it’s just that they’re looking for.
Sometimes they’re not even asking for you to have the answer as the doctor. And I think that’s one of the things we as physicians need to learn and bring the humanity back into our practice. Is that I won’t always have the answer for you. And that’s okay.
But what you’re looking for is somebody to try and figure it out with you and not to brush it off and not to brush you off. And so what has happened is a lot of women I see that come to me, they’re told, you’re too young to be in perimenopause. Like, that’s not what you’re experiencing. Or, I did all your labs, everything is normal. That right there, everything is normal.
14:31 Dr. Ginger Garner: Yes, we should talk about that.
14:35 Dr. LaKeischa: Or, yeah, well, that’s just kind of it and just kind of hold on for dear life and white knuckle it till the symptoms go away. Really? That’s what I’m supposed to do? No, no, not at all. Not at all.
14:50 Dr. Ginger Garner: So, talk about some of the symptoms that from the perimenopausal side, because a lot of them can be missed. One of them I think that’s huge that I see a lot are all the musculoskeletal aches and pains. [Absolutely.] Painful intercourse and things like that, that is actually sometimes 100% hormonal.
Like I don’t even need to do other than lifestyle medicine for hormonal balance, which is huge. Like we could talk about that for days. If they got the hormonal balance right, then they wouldn’t need particular, they don’t need internal pelvic floor PT specifically sometimes, you know, it’s just hormones.
15:30 Dr. LaKeischa: Oh my gosh, Dr. Gardner, we could talk all day. Okay. You are speaking my language. So, There are about 85 plus symptoms. I think even up to almost a hundred symptoms that one of my friends has documented. I call her one of my super friends, Dr. Andrea Donsky, not that, she’s a nutritionist, Andrea Donsky, menopausal nutritionist. And she actually has done surveys in her community of over, I think she has over a hundred thousand women in her community. And she does these simple, these surveys, and she’ll batch these surveys out.
And she told me, she was like, Dr. LaKeischa, the symptoms, it’s becoming more and more, and she’s getting these clusters. So some of the ones that I see that are coming out are, like you said, musculoskeletal. So you all know when you start getting up and you start making those noises, you’re like, oh, ow, oh, wait, oh, you know, or the knees are kind of hurting. Or you wake up and your fingers are swollen. Your brains are kind of, oh, wait, what’s going on?
We know that progesterone and testosterone, for instance, when they start dropping, you’re losing the anti-inflammatory properties that they hold for you. We know that when your estrogen doesn’t go up as high as it used to, or your testosterone doesn’t aromatize to estrogen like it used to, your vaginal health suffers. So you start having dry vaginal area, you can have, now you’re like, wait a minute, intercourse isn’t the way it used to be. Your skin can start feeling different. This is one of those things. Your partner’s touch can feel different.
I said that with my husband one time. We were recording a show and we started talking. I was like, yeah, your hands literally started feeling different over the last couple of years. He was like, what? I was like, yes. And I’d just be like, can you go put some lotion? Like, what is going on? And I was like, but it’s me. Like, my clothes felt different. The fabrics feel different. Brain fog is a huge one. You walk into that room and you’re like, I know why I came in here. There was a specific reason and now I can’t remember.
Or you can’t put your words together like you used to. I call it the word soup. And I’m raising my hand because that’s happened to me. And you can see the words, you know what you want to say. And so you’re like, Am I suffering early set Alzheimer’s? Like, what is going on here? You know, there are temperature dysregulation, of course, some women. A lot of perimenopausal women will say to me, I’m not getting night sweats. Now let’s make that clear. I’m just getting a warmth that kind of makes me wake up or kick that cover off or put that foot out the cover, right? [Oh, yeah.]
Okay. Or, or they’ll talk about body odor changing their body they feel like I’m starting to smell different. One of the other things is phantom smells where you start smelling something other people don’t smell. And you’re just like, what is that smell? What is it? Or you smell, you know, and everybody’s looking at you like, what? I’m raising my hand on that one. That’s a new one for me. And I have been combing the house for it. And we found out that it’s probably that I’m more sensitive to an ingredient in our cleaning products.
So we’re going to change your household cleaning products, because it’s just not pleasant for me anymore. Right? So itchy ears, vertigo, these are just a smattering of those symptoms that you experience in perimenopause. And it seems to be in perimenopause because your hormones are still kind of doing this thing where they go up and down and you haven’t stopped necessarily having your cycle. Your cycle may even change by seven days, either closer together or further apart. And so this becomes very irritating for you because your body literally has changed overnight it seems.
19:41 Dr. Ginger Garner: Yeah and you know to to speak to for um perimenopausal symptoms for women who maybe don’t have pre-existing pelvic health issues but then we layer on what if they have interstitial cystitis. What if they have endometriosis? Then all of a sudden that irritated bladder, the urgency, the frequency. It just gets so much worse.
20:04 Dr. LaKeischa: So much worse. And I’ve seen women that have come to my practice and I’ve been able to treat them with some of the bioidenticals and their symptoms get more manageable or almost seem to go away or disappear, or they have long stints where they are asymptomatic. And they’re like, whoa, why didn’t somebody tell me this years ago? Yeah.
20:33 Dr. Ginger Garner: Yeah, that’s the thing that makes me wince, you know, it makes my heart grip on the inside because, you know, we watched our mothers miss out on that treatment. And I see, you mentioned the question of like early onset dementia, but also the longitudinal fallout of not having been treated.
20:59 Dr. LaKeischa: It is that dementia.
21:01 Dr. Ginger Garner: It is. And it is, I watched both of my grandmothers pass. They were also deprived of any, you know, treatment as well.
21:08 Dr. LaKeischa: Absolutely. And when you’re at this stage in your life and you’re able to look back on your mothers or your grandmothers or your aunts, and you just go, Oh. And you start having more compassion, right? Your heart starts getting bigger and bigger and you’re just like, man, if only, if only.
I even look now at older women in my family and some of the medical challenges that they’re having. I sit back with my scientific brain and I go, you know what? I bet you anything, they wouldn’t be dealing with this, this and this if they had been given this. And, and, you know, and at this stage, they’re in their late 70s and 80s, you know, I wouldn’t say to start any hormone therapy at this stage.
However, I would say, when you start it earlier. I think NAMS at one point, one of their mission statements at one point was saying to at the 10 year mark, maybe have a conversation with your doctor, see if it’s still appropriate for you to be on it. I have patients that have been on it now for that long. And I don’t see any medical indication to stop them because it’s actually helping them to live a healthier life.
So I think in my humble opinion that it’s going to be something that you put in your toolkit like your vitamins. It’s going to be something that is used and utilized for you to be able to live the life you want to live.
22:51 Dr. Ginger Garner: Yeah, yeah. I think that it brings up another good question, which is, um, some of the myths that need to be addressed to avoid just frank medical gaslighting, or even the well-meaning, you know, physician who, if we’re totally honest, how much education, if any, about menopause, do you even have time for?
For example, in PT school, we have absolutely zero time for pelvic health, right? It is a subspecialty. You get your certifications and all of your training after. And so I think one of the myths we first have to bust is that I think people come in, women come in thinking, well, they’re the expert. I’ll just do whatever they said. And sometimes that can lead to trouble.
23:42 Dr. LaKeischa: We’re going to have a good, this is it. I tell women all the time, I’m sitting in the passenger seat, you’re in the driver’s seat. And this is to be a partnership. And you tell me where you wanna go, where we’re headed, which means how do you wanna feel? Like, what are you looking to solve? How would this look if you felt better?
And that way I can put in the GPS coordinates and we can get there together. But you’re in the driver’s seat. I’m not going to be in the driver’s seat taking over because you live in this body every day. So when you come and tell me this is not working, this is not working, I am not to say you’re wrong.
I am to take that information, use my scientific mind and what I have and be able to then go, okay, can I help you out? If I can’t, hold on, let me see if I can find some information or someone else and then let’s figure this out together. Because like I said, women, and I’ve been in the situation myself. Where you show up to the medical community and say, this is what I’m bringing to you. This is what I’m experiencing. These are my signs and symptoms. And because your body didn’t read the textbook that I read, I’m going to tell you, you were wrong.
That’s not right. That’s just not right. And so, like you said, being able to take a step back as a practitioner. I applaud you on this, because when we’re in our training, we only get so much. And if we realize that we are just taught how to learn. That’s really what we are, we are given the basis of this is science. This is scientific information. This is your clinicals. This is how it’s, this is the framework of how it should look. But I’m just teaching you how to go out there and learn because we’re not even taught about perimenopause and menopause in OBGYN world.
26:05 Dr. Ginger Garner: Hmm. Everybody rewind and listen to that again.
26:12 Dr. LaKeischa: Okay. We are not. Yeah. When I was in residency, the most I got was that morning report when my program director walked in and said, we have to stop the women taking this stuff. All I knew was PremPro and Premarin were bad. That’s it.
26:32 Dr. Ginger Garner: Wow. That is such a powerful story. I mean, I have not heard it from the first perspective, you know, first person perspective. I only saw it from the other side of the women in my life just going cold turkey. Yes. And just being terrified. And I hear the same thing when patients come in and sit down and I begin to talk about hormone balance. And the first thing they want to cite is stuff from 2002 is, “Oh, my grandmother had breast cancer. I can’t do that.” Okay.
27:01 Dr. LaKeischa: Right, right. And so I’ve had to learn to honor that belief and that knowledge that they have, and then ask permission, can I give you some new information. And if that person is open to the new information, then we start the conversation. Because I tell patients all the time, an informed refusal is just as powerful as informed consent. Because you need to have all the information that you feel comfortable with to say, you know what, that’s not for me. And that’s the end of the discussion.
27:43 Dr. Ginger Garner: That is such a powerful statement.
So let’s talk about something that is quite, that kind of ups the stakes for women, and that is when you’re melanated, right? So now we’ve got color, which is beautiful, so beautiful, so beautiful. Oh my gosh.
And you mentioned our hearts growing bigger and more compassionate when you think about our family members, the women in our family not being treated appropriately. But then I also felt at the same time, you know, we also have, there’s anger in there, knowing that if you’re a woman of color, it’s not the same. It’s not fair and it’s not right. And it should piss everybody off.
28:29 Dr. LaKeischa: Let me tell you, it is it’s interesting when you’re able to experience life in duality. And let me explain. I’ve been a patient in my own specialty, a couple of times. And the first time I was a patient, actually this is now, the first time I was a patient, I was an intern.
And I had a uterine fibroid that had outgrown its blood supply. And I thought I was having appendicitis. So I call the night, it’s a Saturday night, I call Labor and Delivery, and I’m like, Joanna, who’s the chief resident and who’s the attending physician? Because I think something’s wrong with me. And she’s like, it’s Dr. Reese and Dylan, both men. And I was like, oh, man.
So we hatched this plan, Joanna and I. And she’s like, just come in. I know the ultrasound tech. Just let them look. And if we see anything, then we’ll call them. So fast forward, he sees something, he’s like, you need to get, you need to go in, get registered so I can make a real report. That night, Dr. Reese blesses, he was the nicest attending physician. He says, there is something there. We’re not sure if it’s your ovary or what, if it’s an ovarian cyst or if you have a mass there. He says, Dr. Warner is coming on in the morning.
I’m just gonna keep you overnight, keep you comfortable. And I’ll let her examine you and you all decide what you wanna do. If anything happens overnight though, I’ll step in. I said, no problem. She comes in the next day and she goes, It’s just a simple cyst there, blah, blah, blah. We’re just going to go in, take a peek. I said, go in where? Hold on. Hold on just a second. Where are we going in? What are we doing? She’s like, we’re going to the OR. I was like, wait a minute. What?
I had just been married for four months. She’s like, if push comes to shove, we’ll take the ovary. You just need one ovary to have a baby. That’s all. I was like, okay, hold on. I haven’t even told my parents I’m in the hospital. I’m in California. It was a whole thing. Fast forward, go in. It was a fibroid sitting on top of my uterus that they were able to just shave off and take out. But I was just like, wow. I know that I’m an intern, I know that I’m a doctor, but I would have loved for her to slow down a little bit.
Let me take in the information to be able to go, hold on, you’re going inside my body. You’re going to possibly take out an organ. Let me just take this in. And then fast forward another time that I was a patient was having our first child. And I went into preterm labor and statistics are I had fibroids. I knew that was going to be a possibility, but I was also a doctor on my feet all the time. I was contracting from about 16 weeks of pregnancy and all the way up to 32 weeks when I got put on bed rest.
But the day I had him, because I got put on bed rest for four weeks, we held him in there for four more weeks so those lungs could get a little more mature. The anesthesiologist that came in didn’t recognize me. And as she’s trying to do my epidural, I kept telling her, you’re in the wrong space. You’re in the wrong space. I’m feeling you. This isn’t right. And she’s just like, no, no, no, no. You just, just hold on. You’re just not sitting right. I was like, I’m sitting as still as I can. And you’re in the wrong space.
She got frustrated with me, left the room, came back in, and I guess that short period of time, someone told her who I was. And she comes in and she gets mad at my nurse and says, why didn’t you tell me who this was? I didn’t realize this was Dr. McMillan. And I’m like, it shouldn’t matter who I was. I was telling you I was in pain and I’m uncomfortable. Can we slow down for just a minute?
And those two experiences, for me, are experiences that kind of sit there in my forefront. And that’s why I say I take my time with conversations. Unless your life is at stake and I need to do something to save your life at that minute, I’m going to take the time that you need so that you can understand what’s going on with you. Because I know that everybody’s body is different. Everybody’s body is different.
And so taking into consideration that and taking it into even the perimenopause conversation, there was, I think it’s the Swan study that shows that African-American women, and this was a study where the participants self-identified themselves ethnicity-wise. African-American women enter perimenopause and menopause earlier, and their vasomotor symptoms, what we call vasomotor symptoms, which are like your hot flashes, night sweats, can last up to seven years longer than women in other ethnic groups. And so when my black sisters come to me and they say I’m still flashing and they haven’t had a cycle for like seven, eight, nine years, I know that’s real. And I need to address that.
34:34 Dr. Ginger Garner: Yeah. So I think a big question that everyone will have, I know it’s one that I get all the time because I have to work in close concert with the physicians to make sure that we can dial in the right prescription. So tell me what, what some of the means are, because I think that there’s a misconception. This happens all the time where someone will come in, sit down and say, but my doc said, my labs are fine. And so then we have to, we have to have this conversation about what, what conventional kind of allopathic labs are going to measure and then what functional medicine and integrated medicine.
35:21 Dr. LaKeischa: Absolutely. Oh, I’m so glad that you’re steering us in this direction for the conversation because I have had to tell patients, so there are different modalities that I even use to assess what’s going on with you. So I tell patients there is your regular blood draw that most people are familiar with. You go to the lab, they draw your blood that’s looking at what’s in the serum, what is available floating around.
I also love the Dutch test. That’s one that I like to use, which is a dried urine test, which looks at metabolites. So that can tell me not only did something go into the cell, but there was a reaction that happened that spit out a metabolite on the other side. And I can also look at some enzymatic activity. The Dutch test plus, the one that I really like to use, it also looks at something called your cortisol awakening response in relation to your adrenals. So I can look and see how well your adrenals are adapting to the environment that is you. And then we’re able to look at organic acids, neurotransmitters, and oxidative stress, as well, in there.
There are saliva tests that are available. Saliva tests are a little tricky. You have to be a little nuanced with that because it only looks at the bioavailable component of a particular hormone. And that can be at certain times of the day. So that can be a little cumbersome for some people.
So I tell patients, there’s not just one test. That’s the misnomer. There’s not just one. Ask your doctor, do you use a variety of tests? What modality do you use? Okay, and then there is this concept of your labs are normal. What that means is that they’re looking at a blood test, okay, and they’re looking at the reference range which has been, that has been It is a reference range that comes from looking at a sample of a population that they treat.
Now, we have to now ask ourselves, are we sampling people that may not be as optimal as we would want everybody to be? So you’re looking at reference ranges in relation to the population that that particular lab tests all the time, and the ranges can be very wide. So there’s more optimal range. There’s more an optimal reference point for you to be.
That’s where functional medicine comes in because we look at what is more optimal.
And a lot of times those optimal ranges do match symptom improvement. Which means you may be outside of the reference range of a normal reference range. And somebody will tell you, oh, that’s too high. That level shouldn’t be so. For example, let’s talk about thyroid test.
So there is one test that a lot of doctors like to look at, TSH [Thyroid Stimulating Hormone], which actually has nothing to do with the hormone itself. It looks at a signal. And what we have found is that in endocrinology, they actually had to change the reference for TSH because it was too low. So a lot of what your doctors are saying is normal. I would say if they are not open to looking at other modalities to see if we’re really seeing if the cells are functioning, if the receptors are functioning well. Maybe look and find a functional medicine integrative person that uses a different reference range.
39:19 Dr. Ginger Garner: Yeah, yes. I’ve had, and this is where for all of you listening. Let’s just say you come in, you sit down and your physician, or maybe you’re going to a pelvic PT or OT. They really should be asking to see your existing labs and looking at those things to see what’s available, what has been tested and what hasn’t been. And one of the things that I will find is just say, looking at hemoglobin A1C for looking at diabetes.
And I can tell you have thoughts on it. I cannot wait to see what you have to say about this because this one will just, this will just fire us up even more. I had a person come in and sit down and say, oh, you know, I went to my PA, they said my labs are fine. I said, well, you know, let’s just take a look at them. And I look at them and she is firmly pre-diabetic, like 0.1 points away from being diabetic. And yet there was no therapy offered, meaning lifestyle medicine. Let’s get on this.
And I’m thinking, is this happening because this person is Medicare? Is Medicare not going to pay for that patient education in that moment in time to say, well, you’re pre-diabetic here? There should be like there is in the UK, a group class for pre-diabetes on lifestyle medicine, that kind of thing.
And it worries me. that our insurance companies are saying, well, we’re not going to pay for that. So then it forces and ties the hands of providers. [Oh, it does.] Big systems that says, well, all I can do is tell them it’s fine, even though I know I know that they’re going to be diabetic in a year because they’re right there.
41:03 Dr. LaKeischa: And that is part of the reason I left traditional medicine. Part of the reason was life kind of came and hit me upside one one side and knocked me down the other. Made me step back to take care of my own health. The other reason is that you are constrained by the rules.
And so, like you said, it’s gonna take me about five to seven minutes longer to talk to a patient and sometimes maybe even longer to help them understand what this means if I say you’re pre-diabetic. Well, what does that mean? And for everybody culturally, that means different, that can look different, that conversation can look different.
And so what I have found is that going into functional medicine allowed me the space to say, OK, I’m looking at this number. It’s not quite there yet. I know we’re getting there. And this is what I want you to understand about it. So let’s take a breath because I’ve had people burst into tears because they have the history in their family. They’ve seen the devastation.
Oh my gosh, are you telling me now I’m going to be on dialysis? Are you telling me I’m going to have an amputation on them? I says, no, this is reversible. Let’s take a breath. Because a lot of times when you give people that information, they have shut down from. They’ve gone into their head. Yes.
42:29 Dr. Ginger Garner: Yeah.
42:30 Dr. LaKeischa: So now you have to take that moment, which means I’m taking time from the next patient, which means I’m going to be late, which means my MA is going to have to stay late, which means I’m going to have to pay overtime, which means my boss is going to knock at my door and say, Dr. Lakeisha, you’ve got to pick up the pace.
42:48 Dr. Ginger Garner: Which is the antithesis of the Hippocratic Oath and doing what we should be doing.
42:53 Dr. LaKeischa: Exactly. Exactly. So my biggest message to women and to people that are in a space where their body is changing or something just doesn’t feel right is listen to you. Listen to your body. I know we have said so much today and we’ve talked up the gamut and sometimes it seems so daunting and it can seem as if you know just this conversation here is it really going to make a difference, but it is. Because it’s going to give you some some tools it’s going to arm you with something that’s going to be able to move you to the next. And I always say to patients, you are the master of you. You live with you every day. So if something is different, something is different. Yes. And don’t let anybody tell you that you’re wrong.
43:56 Dr. Ginger Garner: Yeah. That speaks so much to the mental health aspect of it because, you know, in menopause and let’s just say prenatal postpartum, all of the seasons of life, you’re already under such stress because of the biology. But then when you go into the system. And the system might label you with anxiety or depression, and what it actually is, is a lack of support in the system that’s creating the mental health issue. Oh my God. It’s adding insult to injury, right?
44:28 Dr. LaKeischa: Absolutely. Absolutely.
44:30 Dr. Ginger Garner: Yeah. So, to everyone listening, it’s like, you know, maybe it’s not anxiety and depression. Maybe it’s actually the system that created the problem. And then they’re pointing at you and telling you you’re the problem, but it’s not right. Just like you said, something very important and very positive of you can reverse that pre-diabetic state. There is so much that you can do.
So even though we’ve stated a bunch of realities about. Women and medical gaslighting and women of color and medical gaslighting. If it goes from a little trashcan fire, then when you talk about, you know, women of color, it’s like a massive, you know, dumpster fire. Because you’re not listened to and then you’re put off.
So, I also always want women to leave the podcast thinking, well, these are items of action and these are the things that I can do. And you listed several already. Seeking out people who are going to listen. Seeking out people who do not brush off your symptoms. If it’s mental fog or musculoskeletal pain, they’re going to take it seriously. A provider who says, or acts like they know everything is probably a red flag.
45:52 Dr. LaKeischa: Absolutely, absolutely.
45:54 Dr. Ginger Garner: Or operates in isolation, like, oh, I can fix that.
45:58 Dr. LaKeischa: That’s a good one. Operates in isolation. Yes, yes.
46:01 Dr. Ginger Garner: Because the very first thing that I want people to know is, well, we’re going to be working as a team, and we might have referrals left and right and up and down. [All the time.] Yeah, we can’t do it all. [All the time.]
And so what are some of the action items that you can think of in terms of if they didn’t get proper support and they’re still having symptoms. What are the things that, maybe some green flags, and things to look for things to do?
46:30 Dr. LaKeischa: Oh, that’s a great question. I think one of the first things I would say is talk to the person immediately in your family. Whatever the family is to you. If you have a partner, if you have, even if you have a child, say something is going on, like open up to them because we find that women that involve their immediate family in the discussion actually decreases the intensity of their symptoms that they are experiencing in perimenopause and menopause.
So just opening up that conversation and not feeling as if you are alone, and as if you’re this island, you’re in a silo, isolated. Opening that up to your partner, your children, whoever’s in your immediate family, and maybe even in your community. Like, you know, if you have a church family or a social circle that you are a part of, an organization that you’re a part of. Somebody that is trusted that you can say, hey, I’m having a little issue here. I’m having a little problem. I need some help. Or I just need somebody to talk. I just need to tell somebody this, bounce something off of you really quick. Could you help me? Because then somebody may know somebody that knows somebody that can get you to somebody.
47:54 Dr. Ginger Garner: Yes, absolutely.
47: 57 Dr. LaKeischa: So that’s one of the green flags that I say is start shining the light, you know, start shining the light. The other thing I would say is, you know, the internet can be a wonderful place. It is one of those two-edged swords. So it can be a place where, like you said, it could actually be a dumpster fire. Or it could be a light.
So you can find people. I have found a lot of people like yourself on Instagram that are giving information, that are providing information. You can make a consult visit with me even. Just so that I can be able to say, hey, where are you? Where are you located? You know, maybe then I can help direct you to somebody in your area. Or, you know, maybe you are somebody that I could work with directly just because of your location and because of what I can offer you.
But start seeking out, because once you start looking, the answer does show up. It really does. And you have to, don’t shut yourself down and say, oh, well, you know, it just is what it is. I’m just getting old. No, say, you know what? I know that I can feel better. I know there’s a better way. I know that there’s something out there. There’s some type of answer I’m looking for. And it will inevitably show up.
49:19 Dr. Ginger Garner: Yes, yeah, I think that point that you made about reaching out and telling someone. I was treating someone who had had the same issue as you did. And she had an open surgery for it, is doing much better now, but had not gotten pelvic health care and really didn’t have access to it.
And one of the things that she did, she went to, she was out on a weekend trip with girlfriends, and they had been open enough about it, and she’d been talking about her pelvic health journey and that kind of thing. One of the women leaned over to move a boat or something and she was like, my pelvic floor is doing the Lord’s work right now.
50:03 Dr. LaKeischa: I love it. I love it. I love it. I love it. I tell you, if I had had somebody like you, because just to even go back on that, they ended up having to open me. Like I went in with cameras, but the fibroid was too big that they ended up, I have that nice little cesarean scar down there. And I’m now finding about pelvic floor therapist. I was like, where, what I wish I had. Oh my goodness. And so I refer a lot. I refer women to pelvic floor therapists a lot. And I say, you know, there are things, you know, we’ll do Pilates core stuff. I’m like, because your pelvic floor is not isolated. It is a part of you. And like she said, she’s right. The pelvic floor is doing the Lord’s work. Yeah.
50:51 Dr. Ginger Garner: Yeah, this person, this particular person was a singer and so she had lost her voice after surgery and that’s how she found me was the voice to pelvic floor connection. Yeah.
51:03 Dr. LaKeischa: Yeah. Oh, I want to learn more about that. That is awesome. That is awesome. The other thing I would do, I would say Dr. Garner really quickly is thinking about that. I love breath work. I tell women a lot of times breathwork. Breathing throughout the day, alternate nostril breathing or deep belly breathing, or four by four, or some people call it box breathing. That can literally reset that parasympathetic/sympathetic nervous system. And so I believe wholeheartedly in sometimes sitting flat footed and doing that deep breath work, that deep breath work.
51:51 Dr. Ginger Garner: That is such a good finisher because that is where everything kind of begins and ends is with breath work. And using imaging in the clinic, you can see in real time just how much it benefits the pelvic floor and the respiratory diaphragm. So it’s amazing.
You know, I only got about half of our questions. So if it’s OK with you, maybe we can consider a part two of this because I didn’t get to talk about your book. I love it. The Other PMS. We just have more to talk about. So we will kind of end on a high note.
Speaking of music and just a rapid fire question as we close up is, do you have a favorite album, or a song, or a book you’re reading right now?
52:41 Dr. LaKeischa: Oh, that I’m doing right now. Okay, so I have a coach right now that I’m working with. And she, one of my assignments was to pick out a celebratory song that I play and do a full body dance whenever I get something accomplished. And the thing that popped up in my head was “I’m walking on sunshine.”
So that is my song that I play whenever I accomplish a check on my to-do list. That’s one of those things that’s like, oh, I feel like I’m pushing uphill and I get it done. And then I do my whole full body dance and I listen to it for the three minutes. So that’s one of the songs that I’m listening to. I am also listening to an artist. She does some mantras. Let me look at her name. Really quick, just so I can make sure I do that.
54:34 Dr. Ginger Garner: Yeah, we love to drop new artists into our show.
54:38 Dr. LaKeischa: Tony Jones, and it’s T-O-N-I J-O-N-E-S. And the album I’m listening to that I have a couple songs off of is I See Me Mantras. and they are really great. And I am rereading The Fifth Agreement. That is a book that I have just been reading over the last year. And so I love The Four Agreements. I’ve read The Fifth Agreement. I’m rereading The Fifth Agreement. That’s one of the books I’m reading right now.
54:14 Dr. Ginger Garner: Well, thank you. That has inspired me. I’m going to go look up some new stuff. And I always keep a book list. So all y’all, we’re encouraging you go out, pick up a pick up a new book, pick up a new song and sing it even if you can’t sing. Thank you so much, Dr. Lakeisha for being here.
54:32Dr. LaKeischa: Pleasure.
54:34 Dr. Ginger Garner: So appreciate it.
54: 35 Dr. LaKeischa: My pleasure.
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