Interview with Dr. Mary McGue
Topic: Menopause
Guest Name: Dr. Mary McGue
Guest Credentials: Ob/Gyn & Menopause Specialist
Discussion Details: Interview with Dr. McGue, obgyn and menopause specialist at Summit Health in Florham Park and New Providence, NJ. Dr. McGue has extensive training and specializes in working with women who are experiencing symptoms of perimenopause and menopause. We discussed common symptoms of perimenopause and menopause, common concerns around hormone replacement therapy (HRT), how HRT can help manage and resolve your symptoms, and so much more! This interview was conducted by Dr. Tejal Ramaiya, PT, DPT, CSCS, owner and physical therapist at Body Moksha Physical Therapy. Body Moksha Physical Therapy specializes in working with active adults 40+ who are dealing with orthopedic injuries or pelvic floor dysfunction.
Benefits of Watching:
You will learn:
- What are the symptoms of perimenopause and menopause
- What hormone replacement therapy (HRT) is and how it can help with your symptoms
- Common myths and misconceptions around HRT
- Find out if HRT may be a good fit for you
- How you can get help if you’re struggling with perimenopausal symptoms
Address of Guests’ Business: Summit Health
140 Park Ave, 3rd floor
Florham Park, NJ 07932
Dr. Tejal Ramaiya: Hello everyone. Welcome to today’s spotlight series. My name is Dr. Tel Ramaiya. I’m a physical therapist and owner at Body Milksha Physical Therapy in Chadam, New Jersey. And today we have a very, very special guest, Dr. Magoo, who’s an OBGYn at Summit Health. She’s also a menopause specialist. Um, and I’m so excited to have her on this spotlight series today because we get so many questions from women about menopause and who to see and what to do and it’s so hard to find support. So, I’m happy to have you. Thank you so much for taking the time and being here.
Dr. Mary McGue: Thanks for having me. I’m happy to be here.
Dr. Tejal Ramaiya: Yeah, I’m excited. So tell us a little bit about um I know you’re an OBGYn, but like what’s your background and you know go into a little bit about what made you kind of more interested in menopause and specializing in that?
Dr. Mary McGue: Sure. Uh so I went to med school in at Ruckers in New Jersey and then I did my residency in OB/GYN at Atlantic Health in Morristown, New Jersey. Um, and then after I joined Summit Health, which it was one of the groups that I worked with during residency and in my first year at Summit, uh, they had me present to the whole internal medicine department about menopause. Um, before then, you know, our training is fairly limited in med in about menopause in residency. So I was not at all uh experienced in it nor had had much exposure. We spent uh four weeks with a menopause specialist in residency, but even that was fairly limited. So it was like one day a week that she did menopause. So a lot of it was learning on my own. And um so when I presented to the medicine department, it forced me to learn and be up to date on menopause. Um and then the whole medicine department started sending me all of their menopausal referrals. Uh and that was a few years ago. And since that really menopausal medicine has boomed and it’s so popular uh in social media and there have been a lot of uh newspapers, New York Times exposees about the need for menopausal medicine. So I’ve stayed up to date on it and been very interested in it. So, it was kind of forced upon me, but I
Dr. Tejal Ramaiya: But there’s also like such a huge need. And I mean, I don’t know if you have insight on this, but like why do you think it’s become a bigger topic more recently? Is it more because women are just more aware of their health? Is it just there’s just more social media awareness? Is it more because of research studies that have come out?
Dr. Mary McGue: Yeah. Um, I think it’s pretty multiffactorial. there’s uh one the generation of women who are aging and reaching menopause is has grown. So all the baby boomers are really in in the last era of baby boomers are hitting menopause. And then um you know the New York Times wrote this really wild article about menopause and I think that really started all of the like social media awareness online as well as a few like gurus in menopausal medicine that started to take traction. Um, and finally, I think, you know, even two weeks ago, the blackbox warning was just taken off vaginal estrogen cream. And so many people are less afraid of the negative side effects. Whereas, you know, all along OBGans knew, okay, this vaginal estrogen isn’t causing breast cancer, but obviously if you get a prescription and you read that it’s going to cause breast cancer, you’re not going to use the medication. So um I think you know the awareness is amazing and when things kind of take traction on social media then they they keep going. Um, so many patients are seeking uh, practitioners but out of pocket. And I think the greatest part about all of this is now finally you can go see a doctor with your insurance and address your concerns, too.
Dr. Tejal Ramaiya: Yeah. No, that’s true. Because it’s just been so hard to find someone that is wellversed in it. Like have you noticed that any of your other colleagues are learning more about like menopause and specializing in it? Like I know that um Summit Health just recently opened like a menopause center. I’m not sure what they call it. Um so I know that’s relatively new and like how many people work there and like how does that like is it easy to get appointments?
Dr. Mary McGue: So uh there’s five of us that rotate through the menopause center at Summit. It’s in um New Providence. It’s for OBGYNS and then one nurse practitioner who has her menopause certification from the menopause society and um we I think we opened it about a month ago and now I mean it’s so popular now there’s like a giant wait list to get an appointment. Yeah. But the the other aspect of it is, you know, I have a practice in Floren Park and the other four OB/GYNs and nurse practitioner do other things too. So, uh you don’t necessarily need to have a menopause center visit. You can see one of us in our office time. The setting of that is really nice though because it’s like, you know, we’re sitting around a coffee table discussing and you you it’s more relaxed than you know, that’s what an appointment would look like.
Dr. Tejal Ramaiya: Yeah. Yeah. Wow. That’s really cool. So, it’s more um like conversational than you know you sitting at an exam table and us just having a brief discussion during your annual visit. So, that’s been really nice as a provider. Yeah, that’s that’s really cool cuz I know when I initially made my appointment to see you, I did ask on at the front desk about the menopause because I said I have some menopause questions too and they said that I would have to make a separate appointment for that. So then I was like, you know what, I need to get my annual. Let me just set that up. And I was so excited that I could ask you my questions, you know, like I didn’t have to wait another two months. Yeah. So like I mean either way, the main thing is you want to get your questions answered. So I think it was the fact that like you know you could do that in your annual visit, you know, if you just have some brief questions is really really nice so you can get started.
Dr. Mary McGue: Yes. and and I certainly don’t mind talking about anything during the annual visit. Um, but sometimes a menopausal visit can be quite lengthy and people have a lot of concerns and uh symptoms to address. So to get all of that taken care of in the annual visit can be challenging. So the menop having the center and just talking about menopause I think like patients are able really to talk to speak more to their symptoms. often people have like quite a long laundry list of things to discuss and right it’s more casual than okay and we have to do a breast exam and a papsmear.
Dr. Tejal Ramaiya: Yeah. No, I agree with that. I think that if you have and you would that would be the recommendation that you would make during a visit if someone had like a lengthy like you know it would be really good. Yeah, that’s really cool. I love that. Um tell us a little bit about you know you mentioned how HRT’s been more of a conversation that has come up more recently in the past few years. you know there’s so many different options. How do you can you tell us a little bit about some of the options and how you personalize treatments to different people depending on certain situ like just briefly?
Dr. Mary McGue: Sure. So um usually I first go through what kind of symptoms people have. Um the the more common ones are hot flashes and night sweats but people certainly have some of the more uncommon symptoms. So, insomnia, brain fog, um joint pain, frozen shoulder is one of them. That’s probably something you guys see plenty of. And I had that. Yeah. Itchy ears is one. Um and so I go through what kind of symptoms patients have. And then depending on their medical history and risk factors, hormone replacement therapy could be a solution. And then we have other treatment modalities uh like vioza or peroxitine which are non hormonal options for people that have contraindications. Um and as long as they don’t have a contraindication and those the the contraindications to hormone replacement are really do you have a history of a blood clot or stroke um or are you more than 10 years out from menopause or do you have a breast cancer? So pretty simple screening.
Dr. Tejal Ramaiya: Yeah. Yeah.
Dr. Mary McGue: Um, and then I typically prescribe the way that is recommended by ACOG, uh, which is American College of Obstetrics and Gynecology. And that’s an estrogen patch, uh, transdermally absorbed. You put it under your underwear line. And, uh, the reason I give estrogen with a patch is it skips your liver, so it bypasses your liver metabolism, so you’re not getting cholesterol issues or liver function abnormalities. um because those things also arise around menopause too. Uh so we’d rather not have it be the fault of the patch and have it just be physiologic then. And then whenever you take an estrogen, you have to take a progesterone. So um the best way it’s absorbed is orally, which is an micronized progesterone. Um that protects your uterus. So if you take estrogen without progesterone, you will get endometrial cancer. Um and and that’s not something that’s VAT talked about. Um all birth control pills have estrogen and progesterone in them. Um and then hormone replacement therapy has to have both of those things as well. So uh I find many people though with the progesterone orally sleep better. So it’s nice to have that additional pill to take right before bed. Mhm. If people say, “Oh, no. I can’t ever remember to take a pill or um that pill makes me really really drowsy in the morning.” Then you can do a patch with estrogen and progesterone. Um and then there’s also pills that have estrogen and progesterone too. And then finally, what’s become quite popular um which is a great thing is uh testosterone treatment. Um, it’s not FDA approved, but there have been some huge research studies that have supported testosterone treatment for hypoactive sexual desire disorder or low libido. And um, and this isn’t even in this is even in the last couple of months that it’s become at the present and I’ve started prescribing it. Um, and it’s a testosterone cream. It’s just onetenth of the dose of the male dose. So all of those things are are available from your OB/GYN. It’s just a matter of their comfort and prescribing them.
Dr. Tejal Ramaiya: So you mentioned you can do the estrogen and the progesterone as a pill. Um like you could do the estrogen as a pill with the progesterone. Why would you prescribe the pill versus the patch? Like if you like that it’s really for the liver function abnormalities.
Dr. Mary McGue: Gotcha. That’s okay. That’s essentially the only reason I think some people really like taking a pill every single day rather than taking a patch off every three days because the week is seven days. You forget. Yeah. And it’s and it’s annoying when it’s not something you do every day. So I certainly have people that take the pill every single day and it’s just something that gets monitored. Not even from my standpoint. Like I just ensure that patients have a primary care doctor because with your primary care doctor they’ll do your liver function and your cholesterol function annually. So as long as that’s stable then it’s fine.
Dr. Tejal Ramaiya: Okay. All right. Cool. Um you mentioned um about birth control and this might be a silly question but it’s just interesting that there was such a big like scare about you know taking estrogen and progesterone in pmenopause but then why is everyone okay to take it as birth control?
Dr. Mary McGue: Yeah. Um that’s not a silly question. So estrogen, I’m sorry, birth control pills have a much higher dose of estrogen and progesterone than hormone replacement therapy. So the lowest dose of a birth control pill is 10 milligrams a day. And um I typically per 24-hour period. So you can see that it’s like a 20th of the dose, even less than um you’re getting with a pill. And the reason that’s the case is for women who aren’t menrating, they don’t need that much estrogen. In fact, too much estrogen can be um counterproductive and could cause your uterus to start proliferating and you get another period. And after menopause, you really shouldn’t be getting more periods. It’s like a like a light switch off in your doctor’s head like, “Oh, we need to make sure they don’t have a cancer going.” Um, so it’s a much much lower dose. So the transition from a birth control pill to hormone replacement therapy. It that’s like a common discussion in the office is okay, you know, we kind of have to factor in how old the patient is and when their mom went through menopause. Uh to determine, okay, should you come off your birth control pill now and we can transition you onto the hormone replacement therapy if that’s what you want.
Dr. Tejal Ramaiya: Okay, that’s interesting. But there’s no fear for, you know, taking birth control pills. But there’s a fear in women for being on HRT.
Dr. Mary McGue: Yeah. The reason that is is there was this Women’s Health Initiative study that was done in the early 2000s where they gave uh 60-year-old women estrogen, so hormone replacement therapy, and they had to stop the study because women were getting um heart attacks and strokes. Mhm. And that’s really when hormone replacement therapy got shut down. So many people were just terrified of it. Uh and you know since that time that study has been disputed because they were giving 60-year-old women estrogen who hadn’t had it in their body in 10 years. And estrogen the age is hypercoagulable. So of course these people were having strokes or heart attacks. Not of course, but that’s why. Yeah. Um, so when the when those studies were repeated on people less than 10 years since menopause, they weren’t seeing those side effects. So, um, that’s really the difference and why people were afraid of hormone replacement therapy.
Dr. Tejal Ramaiya: So, it’s more the 10 that’s why you guys it’s a contra indication to prescribe HRT for anyone who’s post 10 years menopause.
Dr. Mary McGue: Yeah. To initiate it. But actually now patients can start you know let’s have let’s say someone started a year after menopause we don’t have an end date. It used to be we tried to discontinue them within 10 years because of that big study that was done but now we’re we’re seeing that that’s not actually true. It’s just from the point of no estrogen and then 10 years later. So, I think the the studies and the research are going to come out in the next few years and it’s a good time to be starting HRT cuz we’re going to going to see the benefits of when to discontinue or not discontinue it at all. And there will be there there certainly are benefits to your heart and your bones by being on it too.
Dr. Tejal Ramaiya: Yeah. And that was actually brings me to my next question about preventative medicine. And I think that that’s such a big part of HRT. You know, the symptoms I had were pretty mild and I could have just been like, “Okay, like I had frozen shoulder. Do some PT, you know, like I didn’t have major symptoms. My sleep is fine. I don’t have night sweats. I don’t have brain fog.” But like, you know, I could tell just being self-aware that, you know, I felt like my inflammation was a little higher. So, like that’s why I had a conversation with you. I don’t know if that’s something the average person would do, but um my question is more I feel like, you know, it’s important to start HRT more because of pre prevention and as soon as you start to feel like um your hormone levels are starting to go down, the earlier you start, the less bone loss you’ll have, the less cardiovascular negative consequences you’ll have and all of that. So, I don’t know. Can you talk about that a little bit? What do you think is a good How do people know when to start and how can I guess for you know we talk to patients all the time and when I bring up HRT you know like a lot of people kind of just put up a wall. But you know how do you have a discussion about how this is so important for prevention on and and longevity?
Dr. Mary McGue: Yeah good question. Um, so it hasn’t, you know, we haven’t had the guidance from ACOG, which is the governing body of OBGYNS about it as a preventive treatment. There certainly is research to support it helping with your heart and your bones. Um, and so in the absence of any symptoms, you know, your OB/GYN is cautioned not to initiate HRT. So, um, is it a preventative medicine? In my opinion, yeah. And I think that data will get there. Um, there’s no ideal dose that’s going to prevent a osteoporosis. We know it helps with prevention of osteoporosis, but there’s not a an ideal dose. So, is it go is it 025? Is it 0.5? I don’t know yet. And I think that probably we’ll figure that out at some point. Um, most people are aren’t willing to start a medication unless they have a symptom. So, it it’s not right now. It’s not prescribed for prevention um and treatment of something like you don’t if you don’t have any symptoms. It’s not right now prescribed for that. Will it be in the future? Maybe. Um, is it helpful for people? Yeah. Um, I in my practice I took over from a physician who was very um pro-HRT um during the era where it wasn’t the case. And so I have many patients that um have been on HRT for 20 30 years. And you know, I can’t say for certain that like this is research driven that they don’t have osteoporosis, but they certainly are in very good health. And um I think I think all of that data is forthcoming. Would I start it on someone who just wants to, you know, get ahead of something, you know, with caution? I would definitely have the discussion, you know, we don’t know for certain if this is going to help you. There are risks to starting an estrogen and you know it is hypercoagulable. So it’s really like a patient doctor discussion more so than and no absolutely not. You don’t have any problem. I’m not starting you on it. Um but I think with any medication patients have to know the risk. How much risk is there? without risk factors, not so much. And and I’m sure many people out there are seeking help from like a wellness specialist and paying out of pocket for very similar treatment. And I think it’ll be just an interesting thing to see in the next like 5 to 10 years like yeah, our prescribing patterns change.
Dr. Tejal Ramaiya: Yeah, that’s true. Do you think a lot of more OBGYNS are kind of starting to incorporate, you know, learning more about menopause? And
Dr. Mary McGue: I think it’s become quite polarizing actually. Okay. You know, there’s a group of us that have embraced it and it’s become a big part of our practice. And then there’s others that are like, I’m not learning a new trick right now. Have all my skills and I’m not willing to like keep learning this new trick. So, um, and I think that’s with any medical specialty when I something comes out. Mhm. Are you know my nurse, one of my nurse practitioners and I are like, “Wow, we would be rich if we just started a menopause clinic and took cash only.” But that’s not why you go into medicine. You go into medicine to help people. And people are already paying for their health insurance. So really, they shouldn’t be paying out of pocket for these things. Um, I think many people have like the younger OBGYNS. I’m clearly younger. um are embracing this because this is the future and um I think I think when you find a younger OB/GYN, they might be more willing and knowledgeable or someone that’s going through menopause themselves because our experience triggers you know what we are interested in too.
Dr. Tejal Ramaiya: Yeah, that’s true. That’s true. For sure. What are some of the questions like common questions that women you see tend to ask you or topics that come up during a visit?
Dr. Mary McGue: Um, everyone wants to know about the breast cancer risk with hormone replacement therapy and um I’ve got my spiel down so you’ve heard the spiel before, but um I say and this is the research that HRT does not cause breast cancer. someone with breast cancer, I’m sorry, someone on HRT and someone not, they get breast cancer at the exact same rate. So, it does not cause breast cancer. Um, they also die at the same rate. So, whether or not you’re on HRT, you’re not going to die from breast cancer more often if you’re on it than not. So, it doesn’t give you it and it doesn’t kill you from it. Um, the difference is at diagnosis, it can be more advanced when you’re on HRT. And the rationale that I go through with patients is this. Breast cancer is often hormonally driven. So, it’s either estrogen or progesterone. Um, there’s another factor in there too, but those two things are quite common. So, if you have a breast cancer that’s responsive to estrogen and progesterone, uh, and you’re feeding it extra estrogen and progesterone, of course, it’s going to be more advanced. Um, but I’ve already said that it doesn’t kill you from it. So you might have to, you know, have a mastectomy versus what it was going to be a lumpctomy or you might need chemo and you weren’t going to need chemo. Um, but you won’t die from it. So that’s I think the where people decide I don’t want to do that or I’m okay with this risk. So um I think that’s really the most important question that people ask or if they’re high risk for breast cancer. Um, and then I tell them, you know, if it was me and I was suffering so much, I’m in a doctor’s office talking about hormone replacement therapy, it’s worth a try to see if it makes you feel better.
Dr. Tejal Ramaiya: Yeah. I mean, I’ve heard from so many women how it’s like been life-changing for them to get rid of their symptoms and being able to sleep. I mean, if sleep is one of the issues that you’re having and that’s one of your symptoms, I mean, that in itself, lack of sleep is going to affect your mortality. So like doesn’t it make sense to get a good night’s sleep for years and years and years to help you to live longer? So yeah, the other thing people want to talk about is weight gain. And that has it has never been shown to be a treatment for weight loss. It’s not a GLP one. But if you’re not sleeping like we just talked about and you’re up half the night with hot flashes and you’re sweating all day and your brain’s not working and you’re fatigued, you’re not exercising, you’re not making good decisions, uh you’re probably like your cortisol is probably high and that’s um but once all of those things get under control, people start to eat better. They start to exercise more frequently. uh mood is elevated. So that in itself can cause weight loss, but it’s it’s not like a wonder drug like some of these GLP ones are.
Dr. Tejal Ramaiya: Yeah. Yeah. No, that makes sense. I mean, I do know women who have gone on HRT for the purpose of like hoping they’ll lose weight, but I think that making lifestyle changes first can make a bigger difference. But like it can help support, you know, being able to exercise and eat better just cuz you’re sleeping better.
Dr. Mary McGue: Yeah.
Dr. Tejal Ramaiya: Yeah. Do you um any other like misconceptions or myths that you know like you have heard or that you know of just being in your profession around menopause or parmenopause or HRT?
Dr. Mary McGue: Um, so you know, historically it wasn’t prescribed to women until they went through menopause and were had no more period for a year. And now we’re seeing there’s some benefit for some people starting it when they’re when they’re in pmenopause. And the average age of menopause is 51, but pmenopause can be plus or minus 10 years from that. So um I have started prescribing it to pmenopausal women and seeing if it makes a difference for them. Um pmenopause is you know challenging. We don’t have lab work to essentially say yes you’re in pmenopause. You kind of have to do a little thinking on what the labs show because the range of normal and estrogen is so broad from the lab that we we can’t say okay yes you’re pmenopause. you have to kind of compare a bunch of things to one another, a bunch of different lab tests. Um, so the perry menopause discussion has become very popular. And I f I found that there are many patients in their 40s that want to be started on estrogen as like a, oh, I’m fatigued and I’m tired. Well, you kind of have to tease out. Is that because you know in your 40s your kids are young, you’re not sleeping well, you’re you’re kind of like hitting the peak in your career, so you’re really busy with your job or now your kids are in school and you were a stay-at-home mom and now you’re trying struggling to find like your place in life. So I think the pmenopausal discussion is actually more challenging from a physician standpoint to really isolate. Is this a hormonal problem or is there something else going on? Um for me it’s again just like a risk factor thing. Is am I harming you by starting you on this? If my opinion is no, then I’m okay starting someone on hormone replacement therapy and I have them come back in three months and see are you feeling better or not. Most of the time people have like, oh yeah, I’m feeling a lot better but I I need a little bit more. Oh no, this is perfect. And the people that say no, I have no relief. Nothing got better. Then I become a little more wary like am I actually treating the problem or is there a different problem?
Dr. Tejal Ramaiya: Right. No, that makes sense. So how often do you recommend because some of those things can be also like lifestyle related right like how well are you eating like what’s your nutrition like like you know obviously alcohol intake can affect your sleep and your heart all the things um are you exercising fiber intake like all of the stuff so how often do you recommend lifestyle changes first before doing HRT or do you recommend HRT if it doesn’t help then have the lifestyle change conversation?
Dr. Mary McGue: Usually I try the lifestyle discussion first like are you exercising? Are you eating well? You know, are you making healthy decisions for yourself? What’s your alcohol intake like? Um and actually in our practice, we have like a screening sheet that patients fill out before I even see them. So that has, you know, what are your symptoms and then what’s your alcohol consumption per week. And I’ve actually found like at least my patient population, they’ve really tried the lifestyle modifications first. Um, it’s not it’s not often where someone comes in and they’re like, I don’t exercise and I I eat whatever I want and I want this. So, most people want to do the non-intervention route first and they’ve tried it and then they come to me. But that’s like my patient population. I think most most culturally most people don’t want to be on a medication unless they need it and there’s this huge trend moving towards like natural treatments of everything. So it it hasn’t been too big of a problem. I think people have tried those routes first.
Dr. Tejal Ramaiya: Yeah, that makes sense. So, what are some of the things that you do just professionally to kind of stay on top of um I mean things are changing probably so fast I would think with the medications and treatments available and all of that the research. How do you stay on top of it all?
Dr. Mary McGue: Um there’s a group called the menopause society and they put out so much information pretty frequently on you know changes in the field and uh so and then there’s a couple other OBGYn relatedformational resources I have and a few of them just send you emails every day about updates in the field. So not specific to menopause but their research studies those kind of things. So, like I continue to read um every day about changes. Wow. Because medicine’s changing every day. Yeah. So, and if you’re not up to date, you could harm someone. Um but also, you’re not really helping people if you don’t know what’s happening. So, uh those two things certainly. And then we in our group, in our menopause center group, keep each other up to date, too. And um you know we have like a bunch of different uh communication modalities, email, text message, like oh I have this patient, this is what’s going on with them or did you guys see this study? So there’s a bunch of us that are really making a lot of effort to stay on top of it.
Dr. Tejal Ramaiya: Very cool. Yeah. Awesome. So what’s the most rewarding thing about working with these women?
Dr. Mary McGue: Oh, it’s it’s amazing when they come back at the threemon mark and are like, I feel great. I don’t want to divorce my husband anymore. Um, I’m sleeping at night, have symptoms, I don’t feel rage, I’m successful at my job again. So, it honestly that like 3-month visit when they have success and are feeling like themselves, it’s amazing. And it’s not a hard thing to prescribe. And insurance is covering it for most people, too.
Dr. Tejal Ramaiya: Yeah. Oh my god. Are there certain insuranceances that don’t cover HRT?
Dr. Mary McGue: Historically, they didn’t. Oh, yeah. And in the last year, most people are are getting it covered. The most out of pocket I’ve seen for like a monthly prescription is like $80, $90, which the most part it’s like 15 per person. Yeah. Um Yeah. That’s That’s the best. And that’s an easy one for me. You show up and you’re happy and that’s great.
Dr. Tejal Ramaiya: Yeah. Yeah. Oh, that’s good because I mean it it changes your life that much. Sleeping better. Like I mean it changes your whole life but right how you interact with your husband, your kids, your job. Like that’s like literally I mean obviously life-changing, but that’s amazing.
Dr. Mary McGue: Yeah. There’s been not not a small amount of patients that are like, I I want to know like my I want to divorce my husband. He’s driving me insane and I know he’s there’s nothing wrong with them. I just feel rage and
Dr. Tejal Ramaiya: Wow. Yeah. I I’m like I actually remember my mom going through that. Yeah. Like years ago. And she was just like either really mad or really sad. Yeah. and she was like in her early 50s and like you know she started HRT actually um whatever it was at that time I don’t remember I was in high school yeah did it save that yes it did help her a lot so like and thank god she started it but yeah but I remember blow up your life let’s try this yeah yeah that’s amazing um because you those like changes you get so many changes at this point in your life in your like late 40s, early 50s, your kids are going to college, like your relationship with your spouse changes. I mean, you’re going through pmenopause, all of the things are happening. So, like the more you can like manage your emotions, the better.
Dr. Mary McGue: Yeah.
Dr. Tejal Ramaiya: Um All right, cool. So, is there anything else that I might have not asked you that you want to add or you want women to know?
Dr. Mary McGue: I guess one thing we didn’t touch on is um you know like the vaginal dryness aspect of menopause. So um and I figure that your your network of people is comfortable discussing that too.
Dr. Tejal Ramaiya: Yeah. Especially in pelvic floor PT because that we see that a lot in as a symptom.
Dr. Mary McGue: So the reason you get that is without estrogen you your the cells in your vagina are just not as supple and they become more dry. And there are treatments just for that symptom of menopause which is vaginal estrogen and it works beautifully. And then you know if you are having the systemic symptoms too sometimes just doing the patch and the pill or the pill or whatever route that you choose can help those symptoms as well. So you can kind of ditch the vaginal estrogen. Um but vaginal estrogen is safe and uh with that blackbox warning removed I think people are really more comfortable using it. Um, and that helps not only with symptoms of dryness, but it helps with uh lubrication during intercourse and which which again helps your relationship with your partner when it’s not uncomfortable to engage in like an important intimate part of a partnership. Um, can certainly help your relationship and yourself like you you should to enjoy that the rest of your life, right?
Dr. Tejal Ramaiya: just feel more confident about your relationship and obviously women want to feel attractive. So yeah, all of the things. Yeah. No, that’s good. I’m glad you added that cuz yeah, we didn’t touch on that at all. Is there any um like you know I know we talked about like you know the negative aspects of HRT maybe you know that people thought was true but what are some like mild side effects that someone might um have if they start HRT?
Dr. Mary McGue: Good question. Um, anytime you start an estrogen, birth control, HRT, some people get breast tenderness, um, if like around your period, people report breast tenderness. So, starting HRT, you can have that and that symptom usually dissipates as your body gets used to it again. Um, and then estrogen can cause like a headache, too. Um, so those and and then the most concerning, which is something you should tell your doctor right away, is if you start to have vaginal bleeding because then perhaps, you know, you’re on too high of a dose of estrogen because once you don’t have a period, you really shouldn’t be menrating anymore. Um, the progesterone is fairly limited. There’s not so many adverse effects to it. Um, patients report being sleepy, which is why you take it at night. And I do have some patients who report, you know, I feel bloated or I feel like, you know, I I look bloated. Um, some people say, you know, the fatigue lasts the whole day. So, if those things Oh, wow. Yeah. Everyone’s in different, you know, everyone’s response to medication changes. So, if that’s the case, you know, I can titrate the dose around a little bit, too. And then the other option if the progesterone’s really not well tolerated is something like an IUD. So that protects your uterus too. And it’s not harmful to have an IUD even post-menopausal. Um in fact some of an IUD can be a treatment for precancerous cells in your uterus to avoid surgery. So uh there are different things that we can do. That’s why I have people come back after 3 months because those some of those symptoms we can fix a little bit. Yeah. And then, you know, it just helps the patient be more comfortable because when you start something like a new treatment that’s every day and going to be long term, you want to make sure you’re checking in with your doctor just to make sure you’re feeling good about it. So, yeah.
Dr. Tejal Ramaiya: Very cool. Um, awesome. So, it’s been this was really, really, really informative for me. I mean, and I know that I’ve already had a conversation with you about this, so really really helpful. Um, anything else you want to add?
Dr. Mary McGue: Um well for your profession, pelvic floor therapy is super helpful for you know not just menopausal women but people through all stages of their life. So you’re doing great work too.
Dr. Tejal Ramaiya: Thank you. No, it’s really rewarding to be able to help women. I mean women who are having pain with intercourse like avoiding going out because they’re they’re not sure if there’s going to be a bathroom available, you know, because they have leakage. Like I mean it’s just lifechanging to be able to be more confident in your body and I’m so happy that women are just more aware of all of the treatments that are available when it comes to pelvic floor PT menopause treatment like everything. It’s it’s amazing how far medicine has come in the last like 10 years.
Dr. Mary McGue: Totally.
Dr. Tejal Ramaiya: Or even five years.
Dr. Mary McGue: Yeah.
Dr. Tejal Ramaiya: Even like two. It has been so helpful to women. So, I’m happy that this is a discussion that’s happening and thankful that our patients have options. Historically, I think women are just like, “Oh, this is just how it is and this is just what my life is now.”
Dr. Mary McGue: Exactly.
Dr. Tejal Ramaiya: Yeah. You don’t have to live with it anymore. Um, so thank you so much. Um, so if you are a female woman going through any of these life changes, if you have any of these symptoms or you’re just not sure if these symptoms are pmenopausal or menopausal, like definitely reach out to Dr. Magouch. She’s at Summit Health. Um a regular OBGYn annual appointment or part of the what do they call the specialized group? Is it the menopause menopause center center? And that’s in New Providence. So um you can just go on the Summit Health website. What’s the best way to make an appointment?
Dr. Mary McGue: Yeah, you can go online or you can give the any of the offices a call and they all have the referral to there.
Dr. Tejal Ramaiya: Okay, perfect. Very cool. So definitely you guys can reach out and it’ll be really really good support for you. Thank you so much.
Dr. Mary McGue: Thank you so much.
Dr. Tejal Ramaiya: It was awesome and I will talk to you soon. Have a good holiday.
Dr. Mary McGue: All right. You too. Bye.