Soma Mandal – How To Navigate Through Menopause Transcript

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Host: Welcome to the Lifelong Wellness podcast where we talk to wellness professionals from so many walks of life from around the world and get their insight to living healthier. I’m your host, Wes Malik. Every week we talk about something different, something new. And every week we have a professional who is an expert in their field or their line of work to talk about that particular subject. This week we have someone who is widely regarded as one of America's top physicians in midlife women's health Dr. Soma Mandal who is a board-certified internist who helped thousands of women to successfully navigate menopause and reinvent themselves along the way.  She earned her MD at New York University School of Medicine and a prestigious research fellowship at Oxford University in England. Dr. Mandal brings a fresh perspective to the topic of menopause, particularly for women of different ethnicities. She fuses traditional Western medicine with her Eastern roots and her approach combines the best of both worlds. And her unique approach provides women with a much needed, easy to follow the process, making the 40s and 50s plus very fabulous. Her second book is called Menopause, I Do Not Fear You! and has been published this past fall. You can find it on Amazon, and many major leading bookstores. Dr. Soma Mandal, welcome to the Lifelong Wellness podcast. How are you today?

 Soma:  Good. Thanks for having me, Wes.

Host:  Okay so it's a topic that, you know, a lot of people talk about and a lot of people fear as well. And is menopause something that you should fear?

Soma:  Menopause is definitely not something to fear but understand better so that you can navigate through the process. And a lot of women don't realize that menopause, the onset of menopause is actually a very slow process. The stage before menopause happens can often occur for years and that stage before is called perimenopause. And it can start as late as yours, sorry, as early as your late 30s to anywhere in your early 50s. So, it’s obviously a big range and that’s when the process of the hormones, estrogen, progesterone, all these different hormones slowly decline. And you can be experiencing symptoms like feeling tired and having a decreased libido, having dry hair, dry skin and not realize that these hormonal changes are responsible for it. So my job as a women’s health specialist was is to help navigate and help guide my patients through this so that they understand all of this better.

 Host:  So depending on what stage they’re at during menopause, you will probably treat them differently. Either at the beginning, in the middle, closer to the end or post-menopause as well, correct?

 Soma:  That’s right! So for example, if I have someone who is 42 years old and she is having a few night sweats and maybe some hot flushes, maybe some irritability, I am not necessarily in a rush to put her on medication right away. But there's a lot of education that goes into it. And it is really sitting down and going through what's going on in her life and teasing apart all these different things. We always do blood work and make sure there is no other issues like an underactive thyroid or maybe some diabetic issue. So, these are all things that should be checked for either during a routine physical or an office visit. And then, you know, a lot of education goes into it in terms of how to take care of yourself during these different processes. So, weight gain is common during this stage, so really going over their diet and making sure that people and women are taking care of themselves in the appropriate kind of way.

Host:  Dr. Soma, before we jump into more questions about menopause which is your expertise and what you've written about and the area in which you help people a lot. We asked this question of all our guests and that is what is wellness or living well mean to you personally?

Soma:  I think wellness and living well is to be as educated as possible about your health. For example, when it comes to women's health, people just think about it as a GYN kind of stuff and it’s not. It’s about your heart health, it’s your bone health and it's about your brain health and all of these things spell wellness. If you are not taking care of the whole person then you’re likely not going to be feeling well in addition to that. You know, having a relationship with the patient and focusing on that in terms of taking care of the whole body so that they can feel good about themselves in terms of their health, in terms of their mental health, emotional health as well as physical health.

 Host: And now when we do endeavor to live healthily and women are, you know, living their lives with health consciousness. How does that change when menopause starts occurring or occurs?

Soma: It’s a great question I think you know for a lot of women, working women especially, we are going through so much in terms of taking care of our families, often taking care of an aging parent and working. There are multiple things going on at the same time. So it's really important to take time out and focus on yourself from time to time so that someone can help you understand all the different things that happen to women, not just to menopause but with aging as well. And I mentioned heart health and bone health, so as a woman goes through menopause it's really important to make sure that someone sits down with them and takes a good family history. If there is a family history of heart disease or if that woman has risk factors or heart disease, hypertension, cholesterol, diabetes, then they should have more extensive testing to look into their heart to make sure that there are no clog arteries that may be causing a problem down the line. As we get older women are, you know, more prone to osteopenia and osteoporosis but the menopausal state accelerates that so make sure you get appropriate testing to make sure that you don’t have significant osteoporosis. This all means having a good relationship with your gynecologist and internist to make sure all these tests are being done.

Host: So your book Menopause, I Do Not Fear You!, does it give you people a guide on what menopause is? What is it about?

Soma:  So it is a guide and I basically wrote in very simple language. I don’t think it’s too medical. There are some things but I think it is written in a simple kind of light language so people can read it and understand. You’ll be surprised how many people come in whether it’s men or women, but obviously more women, who don’t understand what the process is. And it still baffles me that you know as kids right there is so much that is explained to us about puberty and when we become mothers, becoming a mother and pregnancy and all of that. But such of the topic of menopause is a taboo subject and I am not sure why. It is a physiologic process that if we are lucky if we get to a certain age all will go through it. And so it is really important for each and every one of us to understand what happens to our body and what symptoms and issues we might have related to that.

Host:  Does it also gives any recommendations on how to deal with it?

Soma: I do go into various things in terms of treatments both alternative as well as the western type of treatments like hormonal therapy. I talk about, you know, research in terms of risk and benefits. I also talk about other things that women can be doing to help themselves feel better whether it’s using like a chill pillow which you can use at night to keep yourself cool. To other measures like having a fan and talking to your employer maybe there are ways of making the space where you work more comfortably. So just things that people don't necessarily think about, but ways of doing things without necessarily having to use medicines, but I also talk about treatments as well, and with that, I talk about what to expect. Like not everybody necessarily has all the symptoms of menopause, but there are some women who experience a lot. And I go into why this happens and the science of it. So, women have a better way of understanding what's happening to their bodies.

Host: You mentioned that there are different types of approaches or different types of ways to, I wouldn’t say, I think treat would be the wrong word, but to approach menopause, one is Western medicine. You mentioned going to your doctor, get yourself checked out, blood work, etc. You have a unique and different perspective on menopause as well, and that combines Eastern medicine and your Eastern roots. Tell us a little bit about that.

Soma:  So, I think being of South Asian-Indian background, you know, I was born and brought up in the USA but my parents are from India and having that exposure to things that, you know, I didn’t learn about in medical school but, you know, maybe by being exposed to my grandmother in India who talked about certain things has always made me a little bit more inclined to understand how different practices work. And I often use things like acupuncture and Ayurveda to help my patients who may not always respond to Western medicines. Add or I use it in conjunction with Western medicine to help what they're experiencing.

Host: So, is it just limited to acupuncture and Ayurveda?

Soma:  They’re different things so there are times when I use a massage. You know, maybe not from menopause but for other types of treatments and, you know, when it comes to muscular issues that are not neurologically-based. So, Ayurveda, acupuncture, massage therapy, these are the kinds of things. And I also go to the book itself. I talk about other types of alternative medications like supplements and herbs that can be used, but you should be talking to someone who is knowledgeable about it and not just take it on your own.

Host: Right. Now, you're an expert and you’ve written about menopause, but you also help people just, you know, through the aging process making 40s, 50s, 60s. You mentioned the word fabulously. (laughing) So, as we grow older and as we age, and particularly your expertise with women aging, what are we supposed to be looking out for as we grow older? And what are the things that we need to do differently to take care of ourselves?

Soma:  Well, I think, you know, as one gets older I knew I would help with this. At least I’ve experienced more wisdom as I get older and I would have done in my 20s completely differently. (laughing)

Host: Yeah.

Soma:  But, there are things to be aware of. So, if there’s a strong family history of heart disease or diabetes, then it’s important to get yourself checked out more than once a year for your physical.

Host: Okay.

Soma:  You may need, you know, earlier stress testing or other types of cardiovascular testing to make sure you don’t have signs of heart disease. It doesn’t necessarily always present as chest pain.

Host: Okay.

Soma:  Diabetes is known as the silent killer and as we get older and especially if you have it in your family and you are at more risk of diabetes. It’s called the silent killer because it doesn’t necessarily have any symptoms associated with it. So, if there is a strong family history or you have risk factors for diabetes, then getting yourself checked out more frequently with your intern is very important.

Host: So, a good rule of thumb is to get yourself regularly checked from the doctor. Would you say every year?

Soma:  At least once a year and then for certain people who have, you know, health issues in the family, it may need to be more than once a year, maybe it would be twice or even three times a year.

Host: Do we need to tell our health professional or doctor what to test us for? Or do we just walk and say, “Hey, I’m here for my yearly physical” and that will cover all these things?

Soma:  Well, you would help that, you know, whoever you’re seeing is able to have a conversation with you where they can tease apart very comprehensive family history and then obviously, you know, go down your own personal history and they can, you know, tailor a plan for you where they’re doing the appropriate blood work and, you know, perhaps sending you to the cardiologist to get the appropriate cardiovascular testing done. But that really involves a conversation and building a relationship with your primary care physician is really important. And that’s what I have in my own practice. I have a lot of patients who see me regularly, whether it be once a year or, you know, several times a year. We try to have a very, you know, detailed conversation when we start off so all the information is there from the get-go.

Host: Are there any questions we should be prepared with in order to have a dialogue with our doctor? Would you recommend that we ask about certain things or just leave it to them?

Soma:  Well, I, for one, am one who always likes someone who looks me in the eye. I’m a doctor but I’m also a patient as well.

Host: Yeah.

Soma:  So, when I go see any doctor I like someone who looks at me right in the eye and is listening to what I'm saying. They ask a lot of questions as well that I might not be thinking of. But, they are trained in asking those questions so they can better understand my health. So, those are two things that I look for right away in any kind of doctor I visit and I always tell my patients who are looking for other specialists that they may be interested in and saying that that's what they should be looking for as well.

Host: Okay. Considering you are an expert with menopause, I like to ask you a couple more questions about treatments that are available.

Soma:  Sure.

Host: Number one, does menopause need to be treated in every case?

Soma:  Menopause doesn’t need to be treated in every case. I think the biggest thing is, a lot of my women patients come in, not realizing what’s happening. Often, and this is the truth, often they just feel like crazy at times because nobody is validating their experience. One of their friends may, you know, joke around and say, “Hey! You know, you may be perimenopausal” or, you know, menopausal, but they need someone to sit there and actually listen to them and validate, you know, whatever is going on and that they are not crazy. So, if someone who is coming in with some mild symptoms and hot flushes and, you know, not sleeping, then I don’t rush to hormones to treat them. So, we talk about maybe writing up their exercise and then trying other ways of keeping them cool, So, I’m not one who throws medications at everyone, but there are women who come in and they can’t work because they are sweating, completely drenched every day and they can’t give a, you know, presentation because their armpits are all drenched. They can’t sleep. You know, they’re having, you know, severe vaginal pain when they’re, you know, having sexual intercourse. So, you know, these are women that often need hormonal treatment. That being said, you know, again we go back to taking a detailed family history. So, there are times when hormonal treatment is contraindicated meaning we can’t use it because it puts that patient at a higher risk of breast cancer, uterine cancer. So, we have to be really careful.

Host: So, is that also called hormone replacement therapy?

Soma:  That’s also called hormone replacement therapy.

Host: So, not everyone should be getting that. That's not what everyone should be concerned about?

Soma:  There are times, you know, that I have to, you know, treat my patients with that, but it’s that conversation that we have about the risks and benefits of the treatment, how long they would expect themselves to be on it, what they should look out for and how often they should see me when they’re on that type of medication.

Host: Apart from hormone-type medication, is there other medication that you prescribe for different symptoms during menopause?

Soma:  So, sometimes and especially if there is a strong personal history of depression, there are times when women may need an anti-depressant or anti-anxiety medicine to help. They may not be experiencing all the other symptoms that can happen with menopause so those kinds of medication can often help or having them see a therapist which obviously does not involve medication. I mentioned alternative medication so there are types of supplements that I sometimes use. Black cohosh is one of them.

Host: Okay.

Soma:  It’s a derivative of the buttercup family and native Americans, I believe, still use it. But they used it for menopause and the way it works is it actually enhances the natural estrogen in the body. So, it can sometimes, you know, if women are having mild side effects, it can also be enough to treat some of these symptoms. But then again, you need someone who has the knowledge to guide them and make them aware of their potential side effects.

Host: If I have an existing condition like diabetes, you mentioned that several times before, will that get worse with menopause? Or will it remain the same? Do I need to be more concerned?

Soma:  So, conditions like diabetes in terms of a direct effect with menopause, probably there is not. But as a woman is going through menopause, the things that are changing are her age, so that puts her at risk for diabetes. There's a battery of hormonal changes that can happen and affect her weight, which can cause insulin issues and put her more at risk for diabetes as well.

Host: If I were to ask you two questions, this is a two-part question.

Soma:  Okay.

Host: One, as a woman, what would I need to expect? Number two here's the tricky part of the question. As a man, son, father, husband, what do I need to know about menopause and how can I play a role? And, you know, during menopause of my significant other, you know, a relative, someone in my family or even a friend.

Soma:  Yes, so for women, I think it's important to just be knowledgeable about what can potentially happen. You know, the science behind menopause, what happens to our hormones and some of the symptoms that can happen. And some women have nothing

and some women have a range of different things. But again, you know, establishing yourself with a doctor who can help you navigate through this is really important. And I mentioned about keeping up with your screening test so that all the other things that you may be at risk for are being checked as well. It’s interesting because, you know, in different cultures and I think in the Western society, menopause is often looked upon at as very like, “Oh, my God. She’s menopausal”.

Host: Right.

Soma:  But in other societies, a menopausal woman is lifted to a higher status and often regarded as, you know, experienced and knowledgeable and she’s been through a lot of different things. So, I think, you know, the thinking needs to be shifted in the way women think about themselves. A lot of women think that their lives are over and they’re not. And in my book, I write about this like this is an opportunity where you can actually transform yourself. So, a lot of women may be empty nesters at this point in their lives.

Host: Yes.

Soma:  Or they’re, you know, just not happy with where they are career-wise or they want to do something different with themselves. So, this is I find a very good stage to reinvent yourself. It’s a placemat where you can say, “You know what, I’m going through this but I’m not going to allow this to bring me down”. And I often feel women feel that way. And I encourage themselves to lift themselves up to do better, to change themselves, to educate themselves, to challenge themselves during this time. And then your second part of the question for the men who may have a menopausal woman in their life is, you know listen, I’m not promoting my book and say, “Oh, you have to go out and get it and read it and understand it”, but I do think a little education is important. So, you know, you may not completely ever understand, you know, what a woman’s body goes through but it is important to know because, you know, sometimes I think men wonder, ”What happened to my sweet wife? She wasn’t like this before”. And sometimes your sweet wife is going through a lot of hormonal changes that are not making her so sweet. So, kind of sitting back and saying, “Okay, you know what, I don’t fully get it but maybe I need to be a little bit more patient with her, maybe I need to ask more questions from her, maybe I need to accompany her when she goes to the doctor so that I have a better understanding of what’s happening with her”. And I think that encouragement, that support would mean a lot to that person. So, that’s what I would say to the second part of your question.

Host: Oh, thank you very much for answering those because it is a topic that's not discussed very publicly. I'm pretty sure privately as well and I truly believe that education might be the key in the answer to a lot of questions that people have and the right education is out there. You have written the book, you can get it on Amazon, it's available, it's priced very reasonably as well. Do you have a blog where you write about these things as well?

Soma:  Yes, I write on various forums. You can find me and my blog on my website, drsomamandal.com, M-A-N-D-A-L.com. And I frequently contribute to different magazines like Prevention and Parade and, you know, Livestrong, different places where I write about women’s health issues as well.

Host: Do you have any plans for writing another book about any other topics or the same topic?

Soma:  So, I’m a Strong Women’s health advocate and, you know, that's where I specialize in. So, I don’t have that lifeboat moment yet, but somewhere down the road, yeah, they’ll be another book coming up. I just don’t know what it is at this point.

Host: Physically speaking, in the physiology of the human body when menopause occurs, is it different for different ethnicities or people from different places?

Soma:  Yes. I’ll give you an example. Caucasian women are more prone to experience menopausal symptoms than Asian women. And even though there’s no known like risk factors as to why this happens, there has been researched that shown that the way you experience menopause can be genetic, it can be linked to, let’s say, how your mother experienced menopause. Whether, you know, there’s some cultural component to that is unknown, but I’m betting that there probably is.

Host: Are there any other differences or you mentioned symptoms, are treatments different?

Soma:  Treatments at least, you know, in the US are, you know, and places like the US and UK and Canada are usually hormone treatments. Again, you know, it really depends on the severity of what you may be going through. There are alternative treatments that are available but if the symptoms are severe enough, hormone treatment is often needed. And I would say that’s worldwide.

Host: Okay, fantastic. Now, as you know, a practitioner of health, you’re a doctor, you got your own practice in New Jersey, you live a very full and active life, you’re a great writer as well, your blog is fantastic as well and I hope people get to read the articles that you write there. What do you think are the major challenges that people face in terms of living healthy or healthfully these days?

Soma:  It says for myself and a lot of my women patients. I think, you know, the biggest issue that I find with my women patients is that they are the caretakers. So, they are taking care of their spouse and their children and, you know, they’re often in a sandwich generation where they have aging parents as well.

Host: Yes.

Soma:  And how that plays out often is the woman stops taking care of herself. She stops having her yearly check-ups, she, you know, maybe forgets to have her mammogram one year or her pap smear. She puts herself last. And as a doctor for women I often, you know, try to remind them like, “You need to be first because if you are not well, then you won’t be able to take care of anybody else as well at the way you want to”. So, they often need to hear that from me, but I find that that’s one of the biggest challenges for a woman who is in her midlife who may or may not be going through menopause, but that is the biggest challenge that I find.

Host: Okay, fantastic. I honestly have run out of questions. (laughing) And I don't know what I should be covering next or if I've missed anything or is there some particular subject we should be talking about and I can ask you a question. Does something come to mind?

Soma:  I think we talked about a lot of different things. You know, I think it’s important for women to just realize that they’re not alone, that we all go through it, we may not all, just like they were when, you know, they learn sex education and puberty and, you know, when they were having their child. There’s a lot of education that happens at that time. The same thing should happen around this stage of life as well.

Host: And I wonder why it doesn’t happen more often? Do we lose touch with women because they're not in school? Because if you're in school and high school you can talk about reproductive health and get the information out but, you know, does anyone approach them at work? Because usually women are working at that age, some are working in the home. Is it harder to reach out to them? Is that why education isn’t there?

Soma:  Yes, I think it’s many different things happening. So, I think around that stage of your life you probably have more people like when you’re going through puberty or you have teachers and other people of your age and you have parents. You know, you have a mom who can help navigate that for you. And midlife, life changes. I think it’s different from when we were in college and high school. And you may not have the close friends that you used to, they may be distant, you know, they live farther away and they may also have a busy life. So, that stage often means that you don’t have those close connections any more. And yes, you’re working. I think I mentioned there’s like a shame about it as well, which I sometimes get because I understand it’s the end of something and sometimes people don’t want to, you know, admit that they have completed a certain stage of life, but it happens. Like I said, if we’re fortunate enough to reach a certain age then this will happen.

Host: Growing old is scary, I’ll give you that. I mean, even I’m terrified. (laughing)

Soma:  You’re terrified? (laughing)

Host: Even I’m terrified of growing old and it’s a scary subject, you know? When my ankle gives out when I’m trying to ice skate after a whole year, you know, I’m like, “Oh, boy! That didn’t happen before. That didn’t happen last year, I must be getting old, you know”. So, it’s kind of, yeah, scary. I kind of feel like threatened by it, too, you know? Yeah.

Soma:  It is scary. It is scary. I think, you know, that’s the beauty of life, you know?

Host: Yes.

Soma:  There’s a finality to it and that’s why we should, you know, enjoy and appreciate each and every day, but with that, yes, our bodies do change. I think different things can trigger these kinds of things. So, I often find when, you know, the last child is about to go off to college or, you know, menopause is happening. Yes, sometimes women can be very emotional about it. I often remind them and my older patients often tell me, “Dr. Mandal, don’t get old”, and I’m like, “Yeah”, but the alternative is not much better.

Host: Right.

Soma:  So, you know, as someone who’s been practicing for many years I get it. I see the gamut of things that can happen to you and I see it within my own self. But we still have to appreciate life itself. And I think if you focus too much on the fact that we’re getting older, you know, you’re not necessarily appreciating the time that you do have.

Host: Okay, very well said. Dr. Soma Mandal, thank you so much for being on the Lifelong Wellness podcast today with us.

Soma:   Thank you very much, Wes, for having me. I really appreciate it.