Transcript
Speaker: Anna Myers is a doctorally prepared nurse practitioner, board certified in women's health, family practice, and urology, as well as SECT certified sexual health counselor. She brings extensive expertise in sexual medicine, urogynecology, and menopause care. connecting pelvic, bladder, and sexual health with the way women feel and function in everyday life.
Speaker: At our menopause retreats, Anna brings warmth, expertise, and a refreshingly open approach to topics that are too often overlooked or left unspoken, from changes to intimacy and sexual desire to bladder concerns, pelvic health, and everyday challenges of menopause. Anna believes women shouldn't have to accept discomfort, changes in intimacy, or bladder symptoms as an inevitable part of getting older. Her passion is helping women feel comfortable asking questions they may have been hesitant to raise, helping them to better understand what's happening in their bodies, and discover that many of the changes they've been quietly living with have effective solutions.
Speaker: So speaking to my patients in the office, I hear every day how lonely perimenopause and menopause can be. It's a long transition. It's not something that lasts a short period of time. And, you know, we see this with The postpartum transition too, it's another time that can be very lonely.
Speaker: And I'm not comparing them, but perimenopause and menopause last for years, whereas that first postpartum year is a year, right? And so imagine if you want that perspective of how long it can be when you feel these physical changes, mental health changes, and you don't have connection to a community. Yeah.
Speaker: Right. And so this is why my colleagues and I started the menopause retreat, because you just can't get everything from social media. Something can not be replaced with real life. And that's what the retreat is about. Connecting with other women, asking questions, getting information from people who know.
Speaker: the answers, who know the evidence, who are keeping up with the research. And although Jean, who is one of our founding members, has taken a step back this year, Anna Myers and I are still moving forward with the retreats because we know how meaningful they are for our patients and our participants. And to be honest, they're super meaningful for us too. So please, everybody, welcome Anna Myers. So excited to have her with us today. my pleasure. I'm so excited to be with you.
Speaker: Absolutely. So I think, you know, the most interesting thing about running these retreats hasn't just been what we've taught women. It's really what women have taught us about the menopause conversation, perimenopause and how that's all changed. Right. So you and I have been doing these for like, honestly, think it's actually four years, which is crazy to me. Time has flown. I had a baby and Yeah, absolutely. Is that crazy? But what has changed from your perspective? my God, so much has changed. I feel like we've seen not only the women that have coming to us, originally just sort of like asking for permissions, like, can I have estrogen, that kind of thing. But now there are so many social media posts, podcasts, books that have been written about what we talk about with these women. And now they come back, you know, more educated and they want to know the details, the nitty gritty. They're looking for strategies, you know, because now they they kind of need more precise information. It's not just like, can I have estrogen? I'm having estrogen, but like, how am I going to have it?
Speaker: you know, right? It's kind of funny if you think back, right? Like our, the first couple retreats we did I'm thinking about like some of the living rooms that we were in and some of the retreat spaces, like we still go back to Walden, but that's was where one of our initial retreats was. And we were really trying to debunk the myths around menopause and perimenopause. And even what the women were telling us then compared to what they're telling us now is different. Oh, for sure. Because they're able to not only advocate for themselves better, but they're not having to fight so hard to get the treatments that they want. Now they're able to, i mean, we have telemedicine all over this country. Women are
Speaker: you know At the same time that this has been going on with menopause, we see the rise in the GLPs. We see the rise in the telemedicine. We see all of these social media, how much influence is there. So the women are coming to us far more educated on menopause, and it's no longer the basics anymore. These women are wanting a strategy. They're like, how am I going to look at the next 10, 20, 30 years of my life? like Tell me how to make that happen so that ah the quality of life that I have is you know it's so important to these women beyond just trying to take care of a symptom here and there. Yeah.
Speaker: Tell us a little bit more about you, Anna, just for anybody who's listening and and getting to know you for the first time, what do you do? What's your role in the menopause retreat? What is like, what's your vision and what's your why? So I am more menopause below the belt. So I take care of helping women learn about overactive bladder, urinary urgency, frequency, leakage, and burning with urination, genitourinary syndrome of menopause, which is a big mouthful, but it's all about those tissues and how much, you know, estrogen plays into those urinary symptoms.
Speaker: I talk about sex, which for some women, they're like, Oh, I'm not sexually active. So this doesn't, you know, affect me. But our vagina is more than just a sexual organ. You know, we have those tissues so much affect our health. So I can have women, you know, they could be sitting in the urgent care for the third time this year, having burning with urination. And they may not be having hot flashes, but they're already experiencing menopause because whether or not they're actually having true urinary tract infections or those tissues are being affected by that lack of estrogen, they're starting to have those symptoms. So menopause could show up in your bladder before it shows up the places that most women would think of.
Speaker: That's so interesting. It reminds me of some of my patients. You know, I've had a few, i mean, more than a few, I've had several patients who tell me, you know, I really only have urgency or I really only have that stress incontinence, like the leakage with cough and sneeze the week before my period. And how fascinating, right? Right.
Speaker: And i I'm like, okay, here's the connection. And we might not know the mechanism yet. And I think like, that's where research is is trying to go. But I could tell them, you know, probably five, 10 years, you're going to start experiencing this every day, not just during those seven days before your period. So that's fascinating that you say like, it might show up there first. And what do you see showing up like for vaginal symptoms? So I guess you mentioned UTIs. You mentioned burning. What else do you see? like first So dryness is one of the things that we hear, just itching, irritation. But at the same time, it doesn't you know you can say, well, I don't have dryness. Well, that doesn't mean you don't have genitourinary syndrome of menopause occurring or starting to occur because that's not the only symptom. Just like painful sex is not the only symptom as well. yeah But again, women can have
Speaker: uncomfortable intercourse, delayed orgasm. It just becomes a little bit more, it takes a little longer to get that orgasm. They don't get quite as wet. They don't have as much arousal. We can definitely see the, like you said, the urgency, the frequency, painful sex for sure. we have women that it can even hurt for them to sit in their chair, like just to be sitting here, that can be uncomfortable for them. So those pelvic floor muscles, you know, have taken a beating for a variety of reasons, things that are going on in their life. So if we think back to the women in our retreats, like, again, what they have taught us over the last four years, what are the things that you've learned about GSM from them that you think is important for other women out there listening to know? And GSM, sorry, is that genitourinary syndrome of menopause? Yeah. So, I mean, for a long time, genitourinary syndrome was called vaginal atrophy. And I feel like that word atrophy just
Speaker: It was hard work. it's It was difficult because made people feel old and it made the tissues feel old and all of that kind of stuff. So it's medically descriptive, but it's insulting. right just exactly just like trick And they didn't understand it either. It didn't really describe what was going on. So I mean, genital urinary syndrome, menopause,
Speaker: it's the urinary part of it is a big part of it for me exactly that I have to take care of for women. So I think for women teaching them that, you know, a lot of their symptoms that they have occurring, their their face kind of lights up. They're like, oh, could menopause really be a part of this? Is that could be what's going on? I'm like, yeah. You know, when did all this start? You see the light bulbs go off. Yeah. I love seeing those light bulb moments. So Helping women appreciate that because, you know, otherwise they're blaming themselves because for years they've heard they're wiping wrong or they're doing this or they're doing that. It's like, no, yeah this isn't about that. This is about what's changed. You know, you weren't getting UTIs before and you're getting them now. You didn't change how you were wiping. It's because of, you know, what's going on with the hormones in your vagina and your urethra and those tissues. And so teaching them about that is so important, takes the blame off of them that they've been blaming themselves for this condition, which is crazy. Yeah, exactly. And I would just add that like, I love when people ask questions that might seem intimate or might seem private, but then everybody else in the in the crowd or in the group is like,
Speaker: Kind of leaning in listening because those questions address what they may be wondering too, but we're too nervous to ask. And so like, you can't really get that in a one on one appointment. That is actually something really special to Yeah, absolutely. That kind of the group think around that where they all are like, Oh, yeah, me too. Yes, you know.
Speaker: I've been having that for a long time, but I didn't appreciate that that was related for sure. So how do women know if it's a UTI or if it's GSM, genitourinary syndrome of menopause? So they need a thoughtful evaluation and a discussion with a provider clinician that is, you know, looking at that specifically. They need urines that are done with microscopy and culture so we can see, is this asymptomatic bacteria? There are women that have bacteria in their urine anyway, as they age that we tend to see and it's not symptomatic. But we also have with the symptomatic ones, you know, we need that urine. So we can see is this actually a urinary tract infection? Or is this actually something that's going on in their vagina, like yeast?
Speaker: bacterial vaginosis? Or is this related to that lack of estrogen that genitourinary syndrome and menopause? Yeah. So okay, I've heard you say this before, I would love for you to repeat it. So what are five things you wish every woman knew before age 45? I wish they knew that their vagina wasn't just for sex. I wish they knew that that was an organ that is a part of their body that The nethers there, that area of their body that they say that down there, you know yeah that that is really important to their health. And I wish that they appreciated that. I wish that that they didn't see it as irrelevant if they weren't sexually active anymore, that those could be definitely a part of their health. and treating that those tissues and treating those organs could, you know, in the long run, if women get UTIs and they get them frequently, you know, we certainly see a lot of women in our country that suffer with them. And yeah they can even have the terrible, as it may seem, sepsis. I mean, they can get very sick from urinary tract infections. So. Yeah.
Speaker: becomes kidney infections, that kind of thing. yeah I wish that they understood that the discomfort that they have with intimacy, that they don't have to tolerate, that there are treatments for it. Women are tough. you know They'll be like, no, I don't have painful sex. Okay, well, let's talk about this. Well, it's a little dry. It's little it's like, okay, well, that is sounds like it's not comfortable, not pleasurable. Does that hurt? Okay, that's the same thing. Okay. That all sounds like it isn't working in for you. So, you know, because that affects their desire. That's the other thing that I talk about at our retreats. I'm a sexual counselor. So I talk about desire and, you know, if women are not having orgasms, if
Speaker: intimacy is not pleasurable for them. If it's uncomfortable, their brain is going to tell them you don't want to do this. So trying to help them. And that even can happen much younger ages than none of us. I mean, definitely I see that, you know, in younger women as well. So kind of teaching them about that because, you know, nobody has taken the time to talk about these kinds of things with them.
Speaker: Yeah. I mean, you have spent so much time of your career actually taking care of men because your work is in a urology department. And I think that that perspective really helps because some of the things I'm hearing you say, like painful intercourse, not having orgasm, like would any of your male patients put up with that and just like keep coming along with it? Yeah. I mean, really what got me going on this in the very first place is that when I went to urology and started taking care of men, every man that walked in the door yeah got a screening tool to find out how their erections and their sexual life was.
Speaker: And no women were. And I was like, right. what in the world? Like, and this is just standard and this has been going on for years. I'm like, really? So, I mean, and you and i we both worked on that getting that screening tool done so that women in our urology offices could be screened for that as well. But yeah.
Speaker: Goodness. I mean, it's just so matter of fact for men and men just talk about this stuff. So matter of fact, like it's no shame around it at all. No shame. I mean, and that's what's so it's so striking, right? Because I trained in OBGYN. And if we're going to send out a screening tool, it's to make sure that you don't have cancer, which is valid. That's like, that's important. And to check in about pregnancy, check in about mental health, all like very valid things. And to me feels so important, but like, we don't ask about how's your orgasm. How's how's your sex life? Not as a screening tool. Like you're lucky if you're gynecologist. I think it's getting better. People are taking the time to ask about sexual function now. But by no means would that be a screening tool that all women would get walking in the yeah door.
Speaker: For sure. For sure. And it was interesting when I started giving out that screening tool, just the responses I would get. You know, certainly they'd be like, well, I didn't fill this out because I'm not sexually active. You know, I'm not here for this, whatever. Yeah. I'd get a handful of those. But then I got so many women that were like,
Speaker: I can't believe finally there's somebody I can talk to about this. yeah Or thank God there's somebody out there taking care of this now because you know nobody's ever asked me about this. And all the years I've gone to the doctor or you know the nurse practitioner, nobody's ever asked me about these questions.
Speaker: Mm-hmm. I think there's two reasons for that, but I'd love to hear your thoughts too. But I think it's about culture, right? Like our North American culture and how that translates into medical culture. But then I also think it's about treatments. Like in urology, people want to know those questions because there is and has been treatment for erectile dysfunction for a very long time. Whereas treatments for women's lack of orgasm or desire, we haven't always had something. And what we have is very, we only have a couple options. We don't have, we don't have a ton of things and they're not all easily accessible, but do you agree with that statement? I mean, that's just kind of been like my own thoughts. Oh, absolutely. Certainly.
Speaker: For sure. i mean, and I feel like even now it's like the treatments are based around not even your own pleasure. It's really about so that you can have, and you know, heterosexual sex with another person. So so you can get through
Speaker: I'm not even sure that it's really, that we're really focused yet on the woman. Yeah. Yeah. no I mean mean, you're right. i question that, you know, is this really about helping the women or? Yeah. I don't know. Yeah. We've come a long way, baby, but you know. Yeah.
Speaker: We've come a long way, but we're not there yet. Yeah. So where do you think we're getting menopause wrong? Because obviously, and I try i kind of make these connections to people. They're like, wait, so you're you're doing female sexual medicine, but then like, how did menopause come into play? And I don't.
Speaker: kind of think of this graph that we see in a lot of our presentations that shows how low desire spikes at menopause, anorgasmia spikes at menopause, like genitourinary syndrome of menopause happens at menopause, right? And that's why female sexual medicine is so tied to menopause. But where do you think that we're getting menopause wrong for women? I think we're really good at talking about hot flashes now. I think we're a really good. Brain fog is coming up. Those kinds of discussions are starting to you know, we can talk about them, but we're not, you know, we haven't arrived yet at talking about these other tissues and organs that menopause affect. We're not great at asking about burning and irritation and, yeah you know, being screened for that. The sexual health issues, certainly need more of that going on, not just in our urology offices, but in our primary care offices. And they have so much to do. i mean, no blame on primary care, but There needs to be screening done. you know We ask about lots of things, but not about the very...
Speaker: apparent things that are going on that then contribute to other health issues like urinary tract infections, incontinence. yeah you know Women that are incontinent, what's going to happen at the end? They end up oftentimes in nursing homes. I mean, like there's a lot of things that we need to treat for lots of other reasons.
Speaker: you know Women need to appreciate their whole health and menopause isn't just about hot flashes. It's also about what's going on in the other parts of their body. And I think that's where you know our retreats come in. We talk about gaining muscle and how to protect yourself from hip fractures. Because you know when you break a hip, your incidence of what can occur to you and death and stuff, that that goes up. So yeah all of this matters. It's not just about the hot flashes. It's not just about treating those one's symptoms that they're occurring right then. It's talking about your overall health. Yeah, you're right. And we have to keep talking about it. Because if we don't, then our patients aren't going to know that they can get help and that there are treatments available. They're not going to look for care, right? So okay, vaginal estrogen, a favorite topic of yours and mine. Yeah, I learned about vaginal estrogen, what 1520 years ago when I was in residency, I didn't know that the rest of the world didn't know about vaginal estrogen. And now I still see as I take care of patients, women who are getting recurrent UTIs, women who are having pain with sex, women who are having pain just from the dryness and have seen multiple conditions and are still not on vaginal estrogen. I mean, thank goodness that they took the box warning off last November in 25. Yes.
Speaker: That was one hurdle that just constantly... constantly. I could give a prescription, I could explain it, but they would take that paperwork home and the pharmacist would give that paperwork out with their prescription, which is probably by law what they're supposed to do. And you know then women would come back and tell me they hadn't started using the treatment. So thank God for that.
Speaker: But there's still so much more education that needs to happen. I mean, i have patients every day, you know they've had years of urinary tract infections and never offered estrogen in their vagina. They're like, what yeah what do you mean estrogen?
Speaker: No. Yeah. Okay. So speaking of the black box warning, being a huge myth that like a mistake to be placed on vaginal estrogen, do you mind if we just do like a rapid fire vaginal estrogen? myth bust. Yeah, that sounds good. Okay. All right. So I will be the patient and you be but the clinician. busster The clinician. Yes. All right. So I'm already on an estrogen patch. Do I still need vaginal estrogen? Oh, this is a conversation that we're going to have because you likely do.
Speaker: So, so why it's just not enough. Like but it's not going to go necessarily to the vagina. So You're going to need some estrogen in that vagina to help build up those tissues, bring blood flow to the area, change the pH. It increases the lactobacilli, the good bacteria. It's going to increase the lactic acid. So I have that conversation with women all the time. There are some women that are fortunate enough that systemic estrogen is enough, but you know a good amount is not.
Speaker: Okay. All right. What if I'm a patient and I'm not sexually active? Do I need vaginal estrogen? I had a patient like this the other day. She stopped using her vaginal estrogen because her husband unfortunately passed away. and so she said, I'm not sexually active, so I'm not going to use that vaginal estrogen anymore.
Speaker: Yeah. Back to your vagina is still relevant to your health and your overall health. So yes, you do need that estrogen. And guess what? Spoiler alert. Then she started getting UTIs again. yeah yeah I had a patient yesterday, 99, know, she was needing the estrogen. We were using a suppository and a cream. So definitely. Okay, great. So, okay, here's another patient scenario. I don't have vaginal dryness at all. So I don't need vaginal estrogen.
Speaker: Dryness is not the only symptom of genitory syndrome of menopause. I'm so happy for you that you don't have dryness. That's great. But but you still are getting UTIs all the time. you know You're still coming and going to the urgent care with burning, but then you don't you have a negative culture or you do have a positive culture. So yeah, you still need estrogen.
Speaker: Okay. The vaginal cream that my doctor prescribed for me is gross. It's messy. I i don't want to use that stuff. Yeah. So we have... a slew of options. We've got tablets, we've got rings, we've got suppositories, we've got all kinds of ways to get estrogen in the vagina. And the other part is that for so many years, people were using the dispenser that came with the estrogen cream tube. And then they were told that they had to use it at night. They had to put it in at night. You know, i I use it in the morning after my shower. I've got my days where I do my hair gel. And I do, on the days I wash my hair, I do my hair gel. That's, you know, every other, every third day. On the other days, I do my vagina stuff, you know? Nice. So you have to kind of come up with your own routine. So I try to help women walk through that and figure out what works for them. Because if it's sitting there on the table at their nightstand, yeah it's not going to help them if they're not using it.
Speaker: I tell people to get a vaginal moisturizer and one day use the estrogen, the next day use a moisturizer. That way they're using something every day. And one day I will have a vaginal moisturizer for people to use. So I don't have to use other products for people. going to put in what I want for them to use that's safe and and good for their tissue and all that. But one day. It's coming. It'll happen. Thank you.
Speaker: Thank you. Last one. all right. a patient has had breast cancer and she's been told by her oncologist she can't have estrogen. So vaginal estrogen must be off the table too.
Speaker: So that is a conversation. We always loop in their oncologist if they're working, you know, whoever they're working with so that we're all on the same team because I don't want to tell a woman. that She can use it. And then she'd go to our oncologist and they say no. But we do have relationships with our oncologist. many of our women that have had breast cancer in the past are on an estrogen product in their vagina. Yeah. i Honestly, I think there's only one oncologist in Cleveland still who's like a very anti-everybody else that I've worked with. I think I've got a little of running list.
Speaker: There's a lot of, you know, this is a big city for healthcare. care There's a lot of oncologists, different types of cancers. It's only two is is not terrible. But think about how many women that those two oncologists are taking care of who are potentially not getting help because of the miscarriage. and gym And then they may not even ask, you know, because we they may not be seeing us, but I mean, they may not be even asking, you know, they just feel like it's not relevant to them. They're like, oh my oncologist told me I should never have cancer. i mean, I know how many women ah I've had that, that even back when their cancers were 20, 30 years ago, and they were just told, nope, never any, I wasn't allowed to do hormone therapy when I went through menopause. They said, no estrogen, you know, they don't appreciate even that there's a difference, systemic estrogen versus local estrogen, low dose in the vagina. There's quite a difference there. So can you explain that difference? Because maybe I i actually haven't clarified that for our listeners. Yeah. So using systemic hormone therapy. So a lot of what we've talked about so far, like when women are having menopause, hormone therapy is given for like hot flashes. You know, the indications in our country are genetourinary syndrome, basal motor symptoms is kind of a fancy word for hot flashes or night sweats.
Speaker: And then for bone health, and then also women in our country who go through premature or ovarian insufficiency, they lose their estrogen early, whether or not it's because of surgeries or naturally. Those are the indications for systemic estrogen. So like a patch or a pill that we can take. But then we have local low-dose vaginal estrogen patients.
Speaker: which is just used in the vagina. It's just a cream that you can rub right into the opening of your vagina. That's where your urethra comes in there. It could be a tablet that they put in their vagina. It could be a ring. I have ladies that, you know, they're in the nursing facility. They can't really do that estrogen for themselves. They come every three months. I put a ring in, take it out, put a new ring in for them. Yeah. It helps prevent their UTIs. It's keeping them from out of the hospital.
Speaker: Yeah, exactly. Yeah. The way I try to explain it, I don't know if this is helpful, is that if you're taking oral estrogen or a gel or patch, like that's treating the symptoms that are affecting your whole body because it's going through your bloodstream. We could detect the estrogen on a blood test, but if you're using vaginal estrogen, it's only going to that area where you're putting that cream tablet or an insert and we're not going to detect it really. We could at very, very sophisticated levels, we could detect a little bit of estrogen, but it's not. It would be a post-anaposal level. It's not like we're going make you 21 again, unfortunately.
Speaker: and And it's not going to touch the other symptoms or issues, right? Like vaginal estrogen, unfortunately, is not going to treat your hot flashes, right? So that's why from the beginning of our talk, we were saying you probably need both. hu So how has all of this changed what we do at the menopause retreat, bringing it back to the retreats? Yeah. So our retreats are becoming a little more sophisticated, I would say, that we're having to kind of really look not only at the just using hormone therapy, but we're looking at your physical health in the respect of now we have a trainer that comes. We have a nutritionist that we have brought on board. We're planning a retreat now with an exciting one in 2027, where we're going to have a gal that, and you can speak more to her credentials than I can, but she's a, looks like a fitness guru and we're excited to have her a part of our retreat. More at Florida, by the way. Whoop, whoop.
Speaker: We're going on location. We're going to Florida January to do that retreat with her. So if you live in Northeast Ohio or anywhere where it gets cold in January and you want to get some sunshine, can join us in Florida. Yeah, I'm excited about that. Yeah, too definitely. And you brought up actually our theme for next year for our retreats as resilience. And I thought that was a brilliant, a brilliant idea. Do you mind sharing why why you suggested we focus on resilience for 2027?
Speaker: You know, I came up with it while I was working, i was going back to school this past year. And when one of my concept papers that I did that was listed as one of the ideas of ah of a theme that you could do. So I really did the paper on resilience and menopause and crossed those two ideas together and just realized how important it is for us to be thinking about menopause. But like, this is an opportunity for women to think about how are they going to live over the next 10, 20, 30 years. And I think that's what you know we're focusing on now is it's not just treating these symptoms that our women are experiencing in the moment. you know We're not just treating hot flashes. We're looking at how can we help them live better yeah and their health for the next you know several decades. Because if you are resilient, if you're hearty, if you got grit, then like you can withstand those changes, those transitions, right? That perimenopause and menopause bring. All right. Last question, because I know we could talk forever, but so Anna, after everything you've learned in treating women urology and sexual medicine and through our retreats, what do you wish that women understood about menopause before they even get there? That they don't have to do it alone.
Speaker: that there are clinicians that care about this, that there are other women that they can share this with, that you know even though they weren't told about it by whoever, the women in their you know lives previously, that there are people that they can connect with, that there are so many options and so many things that they just take for granted as aging you know do not have to occur. And they're not necessarily necessarily just aging anyway. They're related to the changes that are happening and that we have treatments for them now. Yeah. Oh, I love that.
Speaker: Thank you so much. Well, thank you for your time and please check us out at the menopause retreat. So we are doing a little bit of a reorg as we find our putting moving forward without our buddy Jean. She's still around and she's in private practice. You can see her at Cultivate Wellness, but you'll be seeing new website information, new Instagram posts, and most importantly, lots of new opportunities to join us at the Menopause Retreat. So stay posted and follow Anna online and follow the Menopause Retreat LLC. Thank you, Anna. Have a great day.
