Why do you think it's such a cruel system for women like that? Why are women given hysterectomies as a frontline answer to so much, right? And then why aren't they treated with compassion and care?

A couple of basic things up front.

So just for anybody listening, so just make sure, you know, I just want to use proper language.

So hysterectomy is just the removal of your uterus.

A BSO, bilateral salpingo-oophorectomy or bilateral ovary removal, That's what causes menopause.

But I do want to make it very clear that for women who have just their uterus removed but preserve their ovaries, and we do that for lots of reasons, fibroids, you know, endometrial hyperplasia.

There's lots of reasons why women have their uterus removed that is indicated, right? And then there's reasons why, to your point, there are many women who are rushed to a surgical option when fibroids, frankly, we should be first exhausting our medical options for a lot of patients.

So I think it's just so ridiculous that A, it's schedule three, B, that we're put through this insane sort of inquisition.

when I've asked about estrogen replacement, hormone replacement therapy, and you're f- you're sensing that you're getting a, "No, we can't do this," or not really feeling confident, what is the next step? Is it a second opinion? Is it the Menopause Society? Like, where do we go for the information?

So, I mean, I think, listen, we always wanna keep...

W- this has to be a team approach, right? So we wanna include our medical oncologist or our surgeons, along with our primary care doctors and GYNs.

And, and as a patient, listen, I'm gonna just say, frankly, like, this has to be on you because this is the world we live in currently, and we hope to make it better in the future.

But you really do have to take control.

So the first step is to really be very, very clear about what your concerns are and what your symptoms are, and, and do a little bit of, um, you know, kind of education for yourself on, okay, here are the systemic symptoms, like the symptoms of, like, hot flashes and night sweats, and you're concerned about osteoporosis, et cetera.

And then also separate out a little bit, because we can sometimes manage these things a little bit easier, you know, the genitourinary and sexual symptoms of menopause, right? So when...

You know, why is there so much confusion, and how can we kind of like simplify these terms that are flying around?

Mm-hmm

... you talk about we're always trying to inform patients.

Estrogen receptors in your brain, on your skin, on your breast.

Um, males have estrogen receptors on their breast.

Um, children have estrogen receptors on their breast.

So if you develop estrogen receptor-positive breast cancer, it means those tumor cells have developed, they've retained, they, they've kept that estrogen receptor, and they may even overexpress it, right? Because that estrogen receptor can be used to help the cell grow, right? It doesn't mean that the estrogen caused the cancer, right? And so I think that's really, really important, because, uh, when you tell women or women think that, then it, it teaches them to fear their own cancer or k- fear their own bodies and fear their own hormones.

And, um, sometimes it makes them even feel guilty, like, "Oh, did I do something to cause my breast cancer? Was it my birth control pill, or was it that I never got pregnant, or was it, you know, some other reason, or I didn't breastfeed long enough?" Or whatever the reason is.

Um, of a patient that, um, has, you know-Probably been through hell, but now she's on the other side.

Now, what kind of symptoms was she having?

I don't even really know.

At the time, it's a long story, but at the time, my mom was not living in this country, and she had called me and was like, "Oh, just to let you know, tomorrow, I don't know, they think I have these, I don't know, fibroids.

It feels like I can actually feel it, like there's a grapefruit." And my mom is very petite and thin, and I suspect for a number of reasons, she just let her symptoms go.

So she has this surgery, not in this country [laughs], and she tells me everything's okay, and I believed her.

And what was really interesting is right before residency, I got married, and when she got off the plane, when I went to go pick her up before, um, our wedding, I don't know what it was, as soon as she got off the plane, I saw her, and my very first thought in my mind is, "Goodness, she looks like she has cancer." Like, I don't know why that thought came in my mind.

I just think she was a little thinner.

And then all of a sudden they get these diagnoses, and they have to pull back from all those other roles.And someone has to step up to fill the gap