This Is Perimenopause
Menopause isn’t the end, it’s just the beginning. Hosts Michelle and Mikelle are on a mission to help others be better informed than they were when they started their perimenopause journeys. The podcast is a blend of health, education, mindset, and personal growth. Michelle and Mikelle along with their guests are sharing real-life stories and expert advice to help you navigate perimenopause, menopause and beyond.
This Is Perimenopause
Creating Your Perimenopausal Care Plan with Dr. Sarah Shaw
Feeling lost in the fog of perimenopause? Not sure where to turn for help?
Dr. Sarah Shaw, a family physician with a passion for women's health, is here to guide you through this transformative life stage.
In this episode, Dr. Shaw shares practical advice that every woman needs to navigate perimenopause.
In this episode, you'll discover:
- Understanding the obstacles women face in obtaining appropriate perimenopause care
- Recognizing the value of early action and preventive measures in midlife health
- Steps to develop a personalized perimenopause management strategy
- Techniques for becoming a strong advocate for your health needs
- Effective lifestyle adjustments to thrive during the menopausal journey
- Identifying when it's time to consult a menopause specialist
- Promising advancements in women's healthcare, including a spotlight on Dr. Shaw's innovative women's health clinic, Lume
Links for this episode:
- Lume Women + Health Clinic
- Lume on Instagram
- Sign up for The Lume newsletters
- It’s Our Time on Instagram
- National Menopause Show
- National Menopause Show on Instagram
What did you think of today's episode? We want to hear from you!
Thank you so much for listening to the show. Here is how you can connect with us at This Is Perimenopause.
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I think we do not value aging women in our culture and that's a problem. The whole history of medicine is literally built on the male body. We don't teach doctors to know women's anatomy and physiology and menopause, and we don't teach women to know their own bodies. We don't actually talk to women about their genitals and take them through what are their different parts of their anatomy? Have proper language, talk about changes, what's normal, what's not normal. Then why would they know to come and talk to us?
Mikelle:Welcome to. This is Perimenopause, the podcast where we delve into the transformative journey of perimenopause and beyond. I'm one of your hosts, Michele.
Michelle:And I'm your other host, Michelle, and we know firsthand how confusing, overwhelming and downright lonely this phase of life can be.
Mikelle:Join us as we share real-life stories and expert advice to help you navigate this journey and advocate for your best health.
Michelle:We used to think menopause signaled an end, but really it's just the beginning.
Mikelle:The journey to menopause is a significant chapter in a woman's life, one that deserves informed and compassionate care. Yet, too often, women find themselves struggling to find the support they need. In today's episode, we're tackling this gap head on with Dr Sarah Shaw. From social work with women involved in street prostitution to earning a Harvard doctorate in human development and psychology, and then becoming a family physician while starting her own family, dr Shaw's diverse background gives her a unique perspective on women's health. For the past 15 years, she's been practicing family medicine in Toronto and is the co-founder and chief medical officer of Loon, a women's health clinic, opening this fall.
Mikelle:In this episode, dr Shah shares practical advice on creating your perimenopause care plan, advocating for your health and thriving during this transition. She's got some incredible guidance that every woman needs and deserves. We're thrilled to have you with us, dr Shah. Dr Sarah Shah, we are so excited to have you. We've had the opportunity to speak with your colleagues, dr Amy-Louise Bayliss and Dr Waghani Filate, and we're really, really excited to dive in today and talk about your particular area of expertise. So welcome and thank you for joining us.
Sarah:Thank you for having me and thank you for all you're doing to contribute to women's health. It's so needed and it's about time.
Mikelle:Well, thank you, that is a big, big compliment and we will gladly take it. Thank you, thanks, cara. Let's dive in and get into some of why we're so excited to talk to you. Your credentials are really impressive and I think for me in particular you didn't go to medical school until I think it was in your 30s. That's right, and you've accomplished. You've accomplished so much, and you also have a large family. Can you, can you tell us a little bit about that and about your journey? You?
Sarah:know I didn't plan my life. I really I never planned to be a doctor and I can remember the moment in high school which is probably like grade 11, where I said I don't need sciences anymore, I'm done with that, I'm going to be an activist, I'm going to do artsy stuff. I'm done, I don't need it anymore. So really it was the one thing led to another. So I started out doing an undergrad in philosophy and women's studies, which sounds like completely like what a terrible way to get a job. Like that is not. Those are not usable skills. I actually really loved women's studies in particular, but it set the stage for a lens on life and what was interesting to me and I did a lot of work around poverty and injustice and girls and women and it really introduced me to this idea of things that need to change in the world and building community with other women to make that happen. Then I went on to run an outreach program for street prostitutes in Halifax, which was an incredible opportunity. It was such a learning experience. It was very humbling to learn from these women. We hired a lot of women who had worked as street prostitutes, then joined our organization and worked for us. I learned so much from them and always really to be honest and vulnerable and tell the truth. Tell the truth about what you know and tell the truth about what you don't know, because there were so many skills they had that I didn't have. Like we had a lot to teach each other.
Sarah:I then did a master's in social work and I got really interested in girls and women who cut themselves. And my husband well, he was my boyfriend at the time. We drove to Boston for a wedding and he said I think you should go to Harvard, wow. And I said I don't know what you're talking about. Like it was like a road trip. And he's like no, no, I think you should, you should, really, you should do a PhD. And I said I can't do that. And he said, yes, you can. And he, like we parked the car and Harvard has all kinds of different schools, like they have a school of education, a medical school, a school of public health, a law school all that an undergrad, and they're in different parts of the city and we just happened to pull up outside this library. We had no idea. We went into the library and we started to look at the catalog, the course catalog and I realized that all the thinkers that I had been studying in my master's of social work were actually at Harvard Graduate School of Education. I couldn't believe it, like I had never made that connection. So I thought about it and I thought more and more. And and they will let you just come. I contacted the school they will let you just come and attend courses, like for a day, you know, like to just sit in. And I I sent some emails. I said this is what I want to do, like would you meet with me? Um, one person met with me. I I attended a day of classes and then I went and I I couldn't believe I got in, but I did and I loved it.
Sarah:And then, in my work with girls who cut themselves, I said to I asked every single one of them in my research. I said where did you first go for help? And all of them said their family doctors. Now, they didn't often get the help they had hoped for from their family doctors, but what it said to me is my angle into mental health and community was really from a community perspective or from a developmental psychologist or a social worker, and that is still very stigmatizing. More so then we're getting better. But for many people they don't want to go see a social worker, like it has some negative connotations. Even though social workers do some incredibly important work, it still has negative connotations. I thought, what about if I'm a family doctor, I can do that biopsychosocial piece and I get to do some of the stuff that's really great, like wellness visits, developing a relationship with people so that you really know them and you can walk beside them.
Sarah:And then my husband again said you should, you really you should go. He'd been pushing the med school thing. I'm like why are you pushing the med school thing? He's not a doctor. I didn't have the science background. I'm like I'm going to have to go back to high school, like I don't know if I can do that. And he said I know a school you can apply to and he knew about this program called Mac. He said no, at Mac they'll take students like you. So I went and I spent a day at Mac and I thought I'm going to give it everything I've got I'll apply to one program. It's one shot. And I got in.
Sarah:So I went and I was married, I commuted and I commuted with this fantastic guy. He was when he started. He was in his early 40s and he had been a lawyer Wow and decided he was going to go back and be a family doctor. And we commuted back and forth from Toronto and I really hated medical school but I knew it would all be worth it. I love being a family doctor. You know there was a lot of catch-up. I all be worth it. I love being a family doctor. You know there was a lot of catch up. I had a lot of catch up to do.
Sarah:Do you have children at this point? I got pregnant and then I had my first child in medical in residency. I ended up having two children in residency. Wow, I'm not sure that they were thrilled about that, but I'm like I'm getting old, I really want kids. I better get on this. And I got very lucky. I had my last, my second child, two weeks before finishing my residency and they're like you don't have to come back. Well, just like you're good, you don't have to come back and do the rest of it. But I got a mat leave. I'm like no, no, no, no, I'm coming back. I'm coming back to finish my two weeks Because as a physician, you don't really get a maternity leave. So I'm like I need to take advantage of a maternity leave. It might be my last one.
Michelle:Wow, I can't, even, I can't, even. Yeah. So you're already getting no sleep in residency, and then you've got two little boys.
Mikelle:Wow, some newborns to add into the mix. Oh my God, you're, you're incredible. That's, that's incredible.
Sarah:Being up with with kids and my kids when I I've never had a good sleeper in my life until they became teenagers. But you know, when you're woken up through the night in the hospital and resting, see, your heart is just pounding. You're like I hope I don't kill someone, I hope I don't hurt anybody, I hope I'm really helpful tonight. So when I had children, I'm like I can nurse, I can change diapers, Like I got this, Nobody is going to die on my watch at home tonight it felt like a relief.
Mikelle:To be honest. Perspective is so important, wow, okay. So there's the trick for newborn sleeplessness Do residency first. Exactly, it worked Super impressive and we're delighted now that you have taken a special interest in all things menopause. Maybe you could tell us a little bit about how you've developed that interest or where that interest started.
Sarah:When I started my family practice I really loved pediatrics. So I saw a lot of young babies, a lot of newborns, and I saw a lot of women who were just wanting to have their first baby or they came to me when they were pregnant. So really my patients and I aged into perimenopause and menopause together and it became so clear that I didn't have as many skills as I needed to really be agile and address menopause in a way that I wanted to be able to address it, Even though I had been going to conferences like there's some annual conferences in Toronto. I think I was at the first one. We're at like the 20 year anniversary Now.
Sarah:I had started as a resident but I really realized that's not enough. Like prescribing hormones is more complicated, it's more nuanced, the context has been very politicized. It's really scared women and healthcare providers and I didn't have the training to do what I wanted to do in a way which I thought was wholesome care, and I was also having my own symptoms and really very shocked to recognize as a physician that it took me several years to fit those puzzle pieces together. I think if you have for a lot of women, if you have an obvious symptom like suddenly you're drenched in hot, in a hot flash, and you're like sweating and you've had changes in your periods. Then you can pull those pieces together.
Sarah:But there's over 30 symptoms of menopause and many of us may be having the symptoms that are less well known. So I didn't have like a hot flash. I had sleep disturbance, but I had many reasons to have sleep disturbance, as we've just talked about, over the whole course of my life. It got worse Suddenly. I was dizzy, like I was going to see the physiotherapist to get some vestibular help and I was doing all these exercises trying to make it better. I had all kinds of kind of vague symptoms and it took me a long time to pull those together and be like oh, actually, maybe this is perimenopause. And if I'm having that trouble, as a physician who sees women every day, like, what is this like for most of us?
Michelle:Did you have someone to help you through that bit of journey, like help you put those pieces together, or were you just kind of? Did you just wake up one morning and kind of go, oh, who did?
Sarah:you go to. Truly, it was in retrospect that I put those pieces together. It took me several years to figure that out. My life is busy. I have a lot of responsibilities, so I just kept going, and what you learn in your training as a doctor is just keep going.
Michelle:You're training as a woman right Like this is what women learn, yeah.
Sarah:It's like being able to operate on like little sleep. Able to operate on, like little sleep, multiple tasks that are distracting you like suck it up and keep going, and I think I really bought into that, to my detriment. It took me a long time to figure it out, and it was only as I became better at managing menopause for my patients that I really pulled all the pieces together for myself. To be honest, it was not a straightforward path for me.
Mikelle:Yeah, it wasn't for us either, which is why we're interviewing you today. Right, we really struggled, and when we did finally figure out, oh, this is perimenopause, then we couldn't find anybody to help us, and so that's the crux. So I wanted to talk to you for many reasons today, but the crux of it is you know how our listeners, who maybe are on you know on the path toward perimenopause, or maybe struggling now, and they're not quite sure what to do. How can they create their own perimenopausal care plan? Because, as you said, if you couldn't figure this out, Sarah, what hope do the rest of us have? And maybe we could start with why it is so challenging for perimenopausal women to get the care and support they need for their menopausal journeys, what some of the things are that have contributed to that, Because I think sometimes that understanding helps people get to where they need to to get advocate for what they should be getting.
Sarah:I think there are many reasons and I think it's really hard to advocate for yourself when you're in the patient role and I think, as girls and women, we are taught to be good girls. Don't kick up a stink, and that is valued and rewarded socially in our culture is you just go along with it? So I think we do not value aging women in our culture and that's a problem. We, you know the whole history of medicine is literally built on the male body, so we've tested medications on men, not on women. We just simply don't have the same level of research on women's bodies as we do on men. We don't teach doctors to know women's anatomy and physiology and menopause, and we don't teach women to know their own bodies, so they don't know their own anatomy, they don't know when there are changes. Often we haven't, like, for example, taught women to like take a mirror when we do. I really think we need to do this more often in medical practice is actually have a mirror when we're doing pelvic exams and walk women through what we're looking for so that they can recognize changes. Like it's in the same way that we say to people oh how would you be looking out for skin cancer. These are like the ABCDEs of skin cancer if your mold changes. But if we don't actually talk to women about their genitals and take them through what are their different parts of their anatomy? Have proper language, talk about changes, what's normal, what's not normal, then why would they know to come and talk to us? And I think that's gotten even harder through COVID that we've had multiple years where we were relying on virtual visits and women and men were doing a lot more self-diagnosing. So I think that's a part of it.
Sarah:The training in medical school. I got an hour and this was around 2002. And they said it was when the Women's Health Initiative came out and they said take women off hormones. And I really felt like to be a good doctor. It was to take women off hormones and then the pendulum never swung back so that we actually have really good education in medical schools or mandatory curriculum. I mean I have never talked to, I've never had a colleague who tells me they had really good training in menopause during medical school or residency, and that's for family doctors but also for gynecologists. They will tell you the same thing is they've never had the opportunity.
Sarah:You have to be incredibly passionate and proactive to go out and get that additional education, and for most people, what this means is this is after you've graduated. Usually, it's women who are interested in doing this, women who are then trying to repay medical school loans. They may have a family of their own, so they're doing double duty at you know. They have got a double job at home and in the workplace, and then they have to take off time to pay for more education after they're still paying off their medical school debt. I mean, that's a lot of barriers. You have to be pretty motivated to want to do that. This really needs to be a mandatory part of our curriculum, available for all medical students and residents, and I also think we need to have opportunities for practicing physicians, like we have to have days where you don't have to pay multiple hundreds of dollars to come and get a day on giving menopause care. So it's very challenging.
Michelle:Yeah, you've had to jump through all these hurdles to get to this knowledge that you have the chances of women like myself going in and finding a doctor who's managed to get through all those hurdles to have the education that they need to support me. It's impossible, not impossible, but it doesn't exist. I find, um, and we're struggling. A lot of women that I talk to are dismissed and, um, it's I don't know. It's challenging. So how do we? How do we, as women, what do we ask for? How do we get the care that we need if, if our doctors don't even have the knowledge?
Sarah:for how do we get the care that we need if our doctors don't even have the knowledge? I love the list that you developed and when I read that list, like the I think it's called the 10 tips. Yeah, thank you. It's actually like you read my mind. I think they're incredibly important. They're straightforward, but they really do make a difference. So if you have a family doctor yet that you like, even if you're not sure if they're really trained on menopause, I would still say, like, treasure that relationship, keep that person because that person's really important. Maybe they can refer you out, maybe you need to see someone specific for the menopause care, but hold on to that person that you have a long-term relationship with, because there's nothing that can take the place of that long-term relationship. When someone's known you, they know your family history, they know the people in your life, they have a sense of what may have been challenges or what are strengths of yours, but they may still be able to do the menopause care. So I think, what are strengths of yours? But they may still be able to do the menopause care. So I think those simple steps of like, make that your one and only priority for an appointment, like if you have to have, like forms filled out for camp or you're like I can just, can I just refill this prescription? There's such limited time in our medical system that any kind of distractions are really not going to serve you well as a patient and they're not going to. It's going to make it more challenging for the physician. So make an appointment. It's only to discuss menopause issues, like whatever your concerns are, how the reception is what you're booking for. Sometimes people tell you sometimes they don't, because they're concerned about privacy, which is fair Like that's absolutely legitimate to be concerned about that. But oftentimes doctors will see and they'll even take five or 10 minutes to review before they see the patient, and that's really helpful. That's really. Even five or 10 minutes can be incredibly valuable.
Sarah:Think about what you want to discuss and what your hope is. So sometimes people come in and it's really broad. So do you just want someone to confirm, like sometimes you're like I just want to understand, like, is this perimenopause? I don't, you don't actually need to do anything for me today. I'm not ready to start treatment. If you could just tell me like I'm not crazy and this all fits with perimenopause, that can actually be incredibly helpful. Is your goal to like someone talk you through the medications? Is your goal to be referred to a gynecologist? Are you worried because you're having abnormal bleeding, that this is cancer? If you can be clear about, like, what are your top two questions about? What is your hope? What do you hope to get out of that? I think doctors really do. They want you to leave that appointment feeling cared for and if you're able to articulate that, that's really great. If you're not, if you're like I don't know, I'm just kind of feel like a hot mess right now. I just want to have an initial conversation. That's fine.
Sarah:Anticipate having to book multiple appointments, like just as we've talked about, figuring it out is often. It's an evolution, it's a process. Your symptoms are going to change over time how you understand them, how you feel about them, whether you're frightened by them, whether you're ready to take action or think about some kind of treatment. That is a real journey for us. Psychologically. It takes time and in order to do a good job in treating symptoms really it's about you may try one thing. Then you come back Did this work, did it not work?
Sarah:How much did it work? And that's where the tracking piece can come in. The menopause foundation of Canada has has a great tool to fill that out. If you're the kind of person that likes to do that, that that's empowers you, then absolutely fill it out. I'm not that kind of person Like I don't want extra paperwork in my life, but even simple stuff can help.
Sarah:Like often I ask people to say like, how many hot flashes do you have in a day on that first visit?
Sarah:And then when they come back, like so how many hot flashes do you have on average? Like it doesn't need to be a long list, it can be a few things. Or I say like how much improved do you feel since we started this medication? That can be incredibly helpful. 10%. You're like okay, we need to do better than that, much better. But I know it's been a little bit helpful. So maybe if we increase the dose of that medication, for example, there's other things besides medications that help. I also think if your doctor does not is if you're not sure they're not so familiar with menopause care. Dr Sue Goldstein has something called the MQ-6. Dr Sue Goldstein has something called the MQ-6. And it is a brilliant tool and you can fill it out yourself as a patient and just take it in and like give a printout, or you can actually sit with the patient, you can ask the doctor to bring it up and you guys can go through it together.
Mikelle:I like the idea of you could perhaps even book an appointment and say I'd like to go through the MQ-6 tool.
Michelle:Exactly. What is your first line of defense when a woman comes and says I think I might be impairing menopause, I'm suffering, it's affecting my life. What can I do about it?
Sarah:I want to know how much it's affecting somebody's life, because that gives me a real sense of where to go from here. So if someone says to me and I've had women say I am going crazy, you need to help me, I feel like I'm going to kill myself. That truly does happen. So that's one level. If you have someone who says I say how's this impacting your quality of life, your daily functioning, and they say I'm actually managing, okay, I just want to know what my options are. Those are two women who are in two very different places. I mean hormonal treatments. They really do work and I think reassuring women that they have options is incredibly helpful. I think we feel worst psychologically when we feel like there's no choice. This is going to last forever, this is never going to end. This is going to be a continual downward spiral. So if you can give some information and reassurance, or also if my choices are.
Michelle:For instance, when I went to my doctor, my choices were you can go on birth control or you can go on an antidepressant, based on the symptoms I was having, and neither of those sat well with me and I left thinking, oh okay, so I just keep going through this, and I eventually pushed back and got a little further. But what happens if that's the answer that our listeners are getting from their doctors?
Sarah:I'm sorry that was hard for you. Yeah, thank you, and like you're not alone in that Unfortunately you're not the exception. This happens a lot. I think to think about, like really to go back to what is my hope when I go to the doctor. What am I hoping for?
Sarah:I think most often in my experience, women are very help literate. They're very engaged engaged and they want to know all about all their options and they want to think through them and discuss them and then often come back. It's rare when a person says to me I just want this, please just give me this. This is what my sister or my friend was taking, I just want this. That is very rare in my experience. So I think, talking about the range of choices, saying that you really do have options, you should feel empowered to have options and there are lifestyle things you can do that absolutely do help. It does mean you have to take stock and decide that you're going to make that priority out of priority, but absolutely those things help.
Sarah:I mean I wish I had a medication that would solve all the problems. It's just not that easy. It's really the best medication in the world will not be able to make up for poor nutrition, sleep deprivation, serious depression or anxiety. Like really it's a multimodal approach, in the same way that I would approach depression. It's not one thing like giving a pill is is not. It can be a part of the solution, but it's not the whole solution ever. It's always more complicated. But I think sometimes if you can just say to women like I'm going to help you through this, it's going to take multiple appointments and that's okay, that's normal, that is a part of the process, but I'm going to stick with you through this and we're going to figure out what works for you.
Michelle:Can you be everyone's doctor, please, please.
Mikelle:Maybe now is a good time, sarah, you know, for our listeners who are thinking, yeah, it's not that bad, I think I'm okay, who are thinking, yeah, it's not that bad, I think I'm okay. Could we talk a little bit about why understanding what happens in this transition and being mindful about prevention is so important? Because the symptoms can, yes, be very debilitating and hopefully those people are able to get the solutions and build a toolkit with a great medical provider to get to where they need to be. But there's a prevention aspect to this as well. Could you share a little bit about that?
Sarah:Thank you for asking. There most certainly is. I mean, having a check-in at menopause and looking at prevention and optimizing your health is really the gateway to healthy aging Like this is where it starts. This is where our risks increase dramatically Our risk for mental health, for depression and anxiety, our risk for decreasing cognitive function, our risk for cardiovascular disease, our risk for losing muscle bone density. This is really important.
Sarah:We're lucky in Canada that we have a healthcare system, but we have limited healthcare dollars. Our healthcare system is built on responding to illness and disease. It's not built on prevention and health promotion. But that's exactly what women need, especially at midlife. I think there's a few critical developmental stages in people's lives where we need to sit down and take stock, in the same way that when I take care of infants and toddlers like the 18 month visit we know is really key for identifying developmental delays, because that early intervention needs to happen. Then it's the same thing that we should be thinking about that at 40, 45. We really need to be thinking about that.
Sarah:I think bone density is one of the key examples of this. So we know, before menopause, if you've been lucky enough to build peak bone mass, the average woman is going to lose 12% of their bone density through the menopause years and some women are going to lose 20%. Now if we actually had a conversation about what's your bone density now, get a bone density test, talk about what risks are. Did your mother or your sister or your aunt have a hip fracture? Those kinds of things, we can actually prevent you from losing all that bone density. We can help you work on preserving and maintaining the bone density or the health in so many ways that you have now, and to not have those conversations is really a missed that you have now and to not have those conversations is really a missed opportunity which has staggering consequences for women.
Sarah:In the case of bone density, you know you have an osteoporotic hip fracture. 20% of you will die within that year. Half of you will never live independently again. What it does in terms of cost to our society and personal suffering is striking. Wow, I'm sorry that's not a happy thought, is it? But you know what? If we intervene early, we could prevent that bone. We could prevent that loss of bone density. It's not hard. What's hard is dealing with the complications when we don't.
Michelle:What are some of the things we can do for that?
Sarah:So weight-bearing exercise, absolutely so. Whatever you like to do, walking is terrific. Pretty much all Canadians need vitamin D supplementation. Getting enough calcium in your diet. Building muscle will strengthen your bones, and if you'd like to go to the gym, that's great. But you actually don't need to do that fancy stuff. My kids laugh at me because I have weights in front of every TV in the house. Oh, I love that, and when I watch TV with them, I like pick them up, and I'm sure there's neighbors who are like what is she doing again? Like in her pajamas standing in the middle of the living room. They laugh at me when I go to their sports events. They're like I can see you a mile away doing squats.
Michelle:Oh really, oh my God, I love it.
Sarah:You look like a crazy lady. You know like I'm busy. I had five or 10 minutes like I got it in. So weight-bearing exercise, muscle strengthening.
Sarah:But we can also think about hormone therapy. I mean hormone therapy will preserve your bones. Now that may not be a safe or the best option for some women, but for other women, I mean, there's a very clear indication for hormone therapy to prevent osteoporosis. So if you're high risk, you really should have the opportunity to look at what are your risks. So if you're low risk, then doing all these lifestyle things may be perfectly appropriate and hormone therapy may not be a reasonable option for one woman.
Sarah:But if you have a woman who, for example, for one woman but if you have a woman who, for example, is really small, never reached peak bone mass, has like inflammatory bowel disease so she's not absorbing nutrients well and her mother had a hip fracture, that's a lot of risk factors and she's like 40 and you know her bone density is going to dip, she's like super high risk. We could preserve that bone and it means that you could stave off. Maybe at some point you're going to need one of our osteoporosis drugs, but you may be able to put off having one of those drugs for 15 years. That's a really good thing.
Michelle:That's huge and I'm high risk. If I have a history of it on my mother, my aunts, my like, how do I know? If I'm high risk?
Sarah:I mean the big one would be if your mother, like a first degree relative, had a fracture. That would be a big one. But small women, thin women, are actually at very high risk. Any kind of malabsorption is a big risk. The family history alcohol is a big risk. Smoking is a risk factor. High caffeine intake, If you have a medical condition where you have to take oral steroids like prednisone is a common one. So, for example, for someone who has rheumatoid arthritis, if you have to take those oral steroids at a moderate dose for over three months, that would increase your risk and sometimes in those cases we will actually think about giving some medication preventively because we know that they're going to suffer some consequences. The prednisone is really important, but sometimes we need to add in some medication to help protect their bones.
Michelle:Wow, that's fast. I had no idea. Thank you, you're welcome. I understand that you've got an exciting new venture coming to life and it's called Loom and it's a clinic specializing in women's health care. Can you tell us a little bit about this please?
Sarah:I'm so excited every day. I think we're all working incredibly hard. Myself and my three partners were so excited to bring this to life and I feel incredibly grateful to be able to work with this group of smart, committed, fun, warm women fun, warm women and to be able, at 53, to be able to have another opportunity in my life to dive into something I care about so deeply. It's a wonderful opportunity. So we have a space, we're renovating the space. It's in Midtown, Toronto, and we are thinking about women in every detail. You know when we are thinking about women in every detail. You know when we think about the exam beds we're going to purchase. And is an exam bed comfortable? Or do you actually have a warmer where you could warm up, Joe, where you do a pelvic exam? How is the exam bed placed in an exam room? Like what is the lighting, Like? How do midlife women think about themselves? How do they feel in their bodies? How do we make sure that we are a clinic where women feel seen and heard?
Sarah:And I think often in the world, and certainly in medicine, women do not feel seen and heard. And that is our bottom line when we think about the programs we're offering and how we want to approach medicine. It's like will this help a woman feel seen and heard? We know as patients ourselves the experience of not feeling seen and heard and what it's like when you actually feel cared for. And, as a physician, when I rush somebody through, I try not to do that. But when you miss something, when there's a miss on the connection, I feel it, the patient feels it and I know when you get it right, that patient felt cared for. A lot of that is about making sure we have the time, making sure we have practitioners who are incredibly well-educated on women's health issues and the very different ways they can present educated on women's health issues and the very different ways they can present.
Mikelle:Sarah, what if a woman is not feeling seen and heard despite her best efforts? Do you have any recommendations for how she might find a practitioner that will help her achieve her best health? And the second part to that is when should a woman be looking for more specialized care in perimenopause and postmenopause? So when should someone be looking for more specialized care in perimenopause and postmenopause?
Sarah:So when should someone be looking for more specialized care? If you're not feeling seen and heard, if you don't feel like it's a good fit, if you don't feel like your symptoms are managed, then absolutely you need more specialized care. I think it's okay to give some feedback to your physician like this is what I'm hoping for. Where can I find this if you have a family doctor, and where can you find that? So it is increasing. We're getting better. We're not nearly good enough in terms of having the vast array of healthcare professionals who are trained in this, but you could start with a referral to a gynecologist who's comfortable with menopause care. So just because someone's a gynecologist doesn't mean they specialize in menopause care or they feel agile or comfortable doing that. Well, but that's one easy, straightforward option. There's something called the North American Menopause Society. It's now renamed the Menopause Society. They've done the training, they've taken the exam and they can now say that they're certified menopause practitioners. You can actually look at that website and if you Google NAMS, n-a-m-s or the Menopause Society, even the old names will work and you go to the find a practitioner and you can put in your postal code and you can actually find somebody. So that's a really straightforward way to do it.
Sarah:There are some clinics across the country, not very many. Loom is one that will be opening in the fall, so certainly we would be welcome to see any women. There are some virtual platforms that are available. I think virtual care is very important for people who don't have access. That said, if you have not had your blood pressure checked in a long time, if you have not had cervical cancer screening, if you've not had anybody do a pelvic exam in a long time, I would recommend that you actually get one complete like an in-person assessment. If you want to do virtual afterward, then by all means. But I do think we've missed in COVID. We've missed out on a lot of in-person exams, and that concerns me as a physician.
Mikelle:Do patients or women need a referral to see you at Loom, or how does that work?
Sarah:Nope, you can get a referral from your physician or nurse practitioner if you'd like, but you can also refer yourself.
Mikelle:Wonderful, and I believe there is a waitlist currently on your Loom website, correct?
Sarah:We did ask patients to sign up for the waitlist on our webpage. Really, that was about like please stay in touch with us so we can let you know as the clinic evolves and give you information, so that we have permission to give you information about what we're doing at the clinic and so that you can receive our newsletter.
Michelle:What kind of programs are you going to be offering at Loom?
Sarah:Thank, you for asking that. We're so excited about this. So we have four main program offerings. One is menopause support. So really that's everything we've been talking about today how can we talk you through your options and you can make some decisions and also have some follow-up care. So, whatever you, whatever treatment option you decide and that may be lifestyle, it might be hormonal medications, it might be non-hormonal medications, it might be like cognitive behavior therapy for vasomotor symptoms then have some follow-up like how is that working? Is it helping? Do we need to tweak that management plan or are you in a really good place?
Sarah:So that's the menopause support program. We have a program on pelvic health and sexual wellness. So anyone who's delivered a baby will know that there's changes to the pelvic floor. We have changes that just happen with age, with menopause, changes to the vulva, the vagina. Women increase the rate, for example, of urinary tract infections. We see things like urinary incontinence, stress, incontinence. So really it's incredibly common Like, ask a midlife woman to do a jumping jack and, like the whore, like are you kidding me?
Michelle:And yet no one tells us, this is coming.
Sarah:No one tells you and then you get on the trampoline with your kids and you're like, oh my God, I just beat myself. So, really, to deal with pelvic health and sexual wellness, we'll have pelvic physios. That's a really important part of care as we age and Canada's very behind on that. If you live in the UK, if you live in Germany, you will automatically have pelvic physio after you deliver a baby and whether you've had a baby or not, you're still going to have changes to the pelvic floor. So it's really dealing with those issues, but also saying, like women can have a sexual life midlife and beyond. And if that's important to you, then that's important to us and I think women have not really felt liberated to embrace that they can, that, like you can say, I want a healthy sexual life. That's important to me, that's a really important part of my quality of life and we don't say that a lot. That's like off the table for for women after they've they've given birth and that's not okay. We want to change the landscape so that women have an opportunity to embrace their sexuality in whatever way that they see that. So those are the first two programs.
Sarah:The third program is something called LoomSpan, and LoomSpan is all about prevention and health promotion. So it's about having an opportunity to take stock of where you are now and so that you have an opportunity to reflect on what you need to do to be where you want to be in 10, 20, 30 years. So if you want to be able to in 20 years, if I want to be able to lean over and pick up my 30 pound grandchild and make sure I don't get a vertebral compression fracture because I'm very high risk for osteoporosis, then I need to think now, like what is my bone density now? What is my muscle strength now? Like, if I can't do a squat with a 30 pound weight now, I'm not going to be able to lift up a 30 pound child in 20, you know, 10, 15, 20 years. So really thinking about that. So thinking about cardiovascular health, metabolic health, brain health, mental health, bone and muscle health and how can we help put women in the driver's seat of their health?
Sarah:So if you don't have an assessment, if you don't take stock now, you may be great, like maybe you take terrific care of yourself and you walk every day and you get a good night's sleep and all that stuff, but I think for most of us we actually need a formal check-in, not only the testing and the investigations, but also a check-in to say okay, I need a minute to think about me. Women take care of their families, they take care of everybody else. Sometimes they're not as likely to find the time to take care of themselves, and the last program that we'll offer is something called a PHA, so it's a personal health assessment. So it's a very thorough quarter day sorry, three quarter day, like you come in from, like eight to one that kind of thing, and we do blood work, we do stress testing, we do like that whole formal testing in one day and then we give you feedback.
Michelle:I love this. This is amazing. I can't wait. I'll be there day one. We would love to see you, and do I have to live in Ontario to be a loom patient?
Sarah:So you could come to our clinic from anywhere. You would not have to be a patient. We're still working through what are the regulations from a virtual care perspective. So there are some rules around that which we don't have any control over, and it varies by province, but if you're in Ontario, of course, okay, thank you. Yeah, you're welcome.
Michelle:I'm there.
Mikelle:Front and center, dr Sarah Shaw Amazing. Thank you so so much. We had some other questions, of course, that we didn't get to today. We would love, love, love, love, love to have you back. You know, I think it would be great if we could spend some time again talking about medications that women should be familiar with, whether they're hormonal, non-hormonal, so that they can go to their doctor. And I think sometimes, if you can give your doctor some comfort that you're well-versed and that you understand some of the risks, they might be more amenable to helping you pursue an option that they may not have otherwise done for you. So, yeah, if we could maybe coerce you now on recording to say, yes, he'll come back, that would be great.
Sarah:I'd love to Yay, I'm all in. Thank you, yeah, I would love to Yay, I'm all in. Thank you, yeah, I would love to.
Mikelle:Okay, we would love that we will get that on the books sooner rather than later, because the world needs more Dr Sarah Shahs, and if we can bring a little bit of you to our listeners every now and again, I think that is a job well done on our part, that's lovely and for all of our listeners.
Michelle:there will be all of the contact information and loom information and everywhere to find Dr Sarah Shaw and her colleagues in the show notes, so don't forget to check those out, Sarah, before we let you go. What is the one thing you want every woman to know about perimenopause?
Sarah:It's not in your head, it's real, and you truly do have good options.
Michelle:Amazing, excellent answer. Thank you so much. It's amazing.
Sarah:Thank you for everything you guys are doing really, and I especially love when you have those funny video clips in the weekly email. I love those, I laugh over those and I always seem to like I wake up and and there'll be those clip. It's like the best way to start the day. So please, more clips. I really get such a kick out of them and you're making the world a better place for women.
Michelle:So thank you, thank you, thank you and thank you for everything that you're doing. It's incredible. You're an incredible woman. I'm so honored to know you. Thank you.
Sarah:That's way too kind.
Michelle:Thanks so much for listening to the show. If you like what you hear, please take a moment to rate and subscribe to our podcast. When you do this, it helps to raise our podcast profile so more women can find us and get a little better understanding of what to expect in perimenopause.
Mikelle:We also read all the reviews the good, the bad and the ugly, to help us continuously improve our show. We would love to hear from you. You can connect with us through the podcast, on social media or through our website. Our information, as well as links and details from our conversation today, can be found in the show notes. This podcast is for general information only. It's designed to educate, inspire and support you on your personal journey through perimenopause. The information and opinions on this podcast are not intended to be a substitution for primary care diagnosis or treatment. The information on this podcast does not replace professional health care advice. The use of the information discussed is at the sole discretion of the listener. If you are suffering from symptoms or have questions, please consult a qualified health care practitioner.
