Hormones aren't the problem. Misunderstanding them is. On this episode of BackTable Women’s Health, Dr. Karen Toubi sits down with Dr. James Simon to discuss menopause, sexual medicine, and his career journey from early IVF research to treating aging women. They also unpack his Green Journal paper with Dr. Barbara Levy, challenging common misconceptions about hormone therapy and explaining why treatment should be individualized because not all estrogens and progestogens are the same.

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Timestamps

00:00 - Introduction
03:11 - Why Menopause Medicine
07:51 - Hormone Therapy Paper
11:48 - Counseling Perimenopause
16:14 - Unopposed Estrogen Strategy
23:01 - IUDs And Progesterone
26:54 - Estrogen Types Explained
34:59 - Thrombosis Risk Approach
43:11 - Oral Estrogen Use Cases
44:48 - Breast Cancer Risk Counseling
46:49 - Estrogen Risk Myth
48:11 - Pregnancy and Breast Cancer
50:09 - Counseling BRCA Patients
53:26 - Duavee: Who Benefits?
55:32 - Bazedoxifene Access Limits
57:47 - Ospemifene for Genitourinary Syndrome of Menopause (GSM)
01:00:37 - Dryness Explained
01:02:41 - Thrombosis Risk Screening
01:05:01 - UTIs and Vaginal Estrogen
01:07:18 - Starting HRT After 60
01:12:47 - Window of Opportunity
01:14:46 - Staying on HRT
01:16:43 - Blood Levels and Absorption
01:20:13 - Clinician Takeaways

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More about this episode

The conversation explores strategies for managing perimenopause, including when hormonal contraception is the best option and when symptom-focused hormone therapy may be more appropriate. They cover practical guidance on using transdermal estradiol, Mirena and Liletta for contraception and endometrial protection, and how thrombosis risk differs depending on the type and route of hormone therapy. The episode wraps up with a discussion on newer treatments for genitourinary syndrome of menopause, when to consider hormone therapy, and why clinical experience is so important in menopause care.

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Resources

A Contemporary View of Menopausal Hormone Therapy https://journals.lww.com/greenjournal/abstract/10.1097/aog.0000000000005553~a-contemporary-view-of-menopausal-hormone-therapy?redirectionsource=fulltextview

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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The standard infertility timeline does not apply to every patient. When should infertility counseling begin, and when is it risky to wait? OBGYN Dr. Nicole Faulkner and REI specialist Dr. Jennifer Kulp Makarov discuss how age, irregular cycles, endometriosis, recurrent pregnancy loss, and male factor infertility should shape counseling and referral decisions on this week’s episode of the BackTable Women’s Health.

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Timestamps

00:00 - Introduction
02:37 - Launching a New Practice
04:23 - When to Refer Patients
06:23 - Basic Infertility Workup
08:39 - Counseling Patients Over 40
14:05 - Personalized IVF Protocols
17:59 - Embryology and PGT-A
23:54 - Egg Preservation Timing
28:20 - Using Frozen Embryos Later
31:36 - Components of Personalized IVF
33:30 - Patient Experience and Education
37:25 - Alternative Fertility Options
40:46 - Approaching Recurrent Miscarriage
42:28 - Key Takeaways

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More about this episode

Dr. Kulp Makarov reviews when patients should be referred to an REI based on age, while emphasizing that earlier referral is appropriate for patients with irregular cycles, endometriosis, recurrent pregnancy loss, or known male factor infertility. Although anti-Müllerian hormone (AMH) testing can be a useful initial assessment, it should not delay specialist evaluation. The discussion also explores how advances in reproductive medicine have expanded fertility treatment options. Dr. Kulp Makarov highlights personalized IVF protocols, embryo banking, and preimplantation genetic testing, while emphasizing both the benefits and limitations of these approaches. She also shares practical guidance on egg freezing, pregnancy in the mid-40s, and when donor eggs, gestational carriers, or other fertility treatment options may be appropriate. Finally, she explains how REIs approach the evaluation and management of recurrent pregnancy loss.

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

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How can OBGYNs navigate the complexities of modern prenatal carrier screening? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Mary Kate LoPiccolo, a pediatrician and medical geneticist at Mount Sinai, to break down the essentials of prenatal carrier screening in OBGYN practice. They discuss what carrier screening is, when to order it, and how to manage and interpret results in real-world clinical settings.

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Timestamps

00:00 - Introduction
03:03 - Understanding Carrier Screening
04:40 - Partner Testing: When and Why
06:22 - Selecting the Right Panel Size
08:27 - Managing Time Constraints and Making Referrals
10:52 - Pretest Counseling Essentials
16:44 - Decoding Results and Effective Reporting
20:52 - Limits of OB Counseling
26:19 - Navigating Common X-Linked Pitfalls
30:11 - Equity, Costs, and Over-Testing
36:11 - Tele-Genetics and Lab Resources
43:43 - Final Takeaways

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More about this episode

Dr. LoPiccolo reviews the evolution from Tay-Sachs screening in Ashkenazi Jewish populations to today’s pan-ethnic expanded panels, emphasizing carrier screening as a blood-based screening test for recessive and X-linked conditions ideally performed preconception and for both partners. The conversation covers panel size selection, best practices for pre-test counseling, common pitfalls with X-linked results, documentation and report interpretation, cost and equity barriers, and the value of referrals, telegenetics, lab genetic counselors, and resources like GeneReviews to optimize care.

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Resources

GeneReviews - https://www.ncbi.nlm.nih.gov/books/NBK1116/

Open Evidence - https://www.openevidence.com/

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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As over-the-counter continuous glucose monitors (CGMs) become more common, clinician guidance matters more than ever. In this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Nicholas Canelo, a family medicine physician and founder of the Perlman Wellness CGM program, to discuss how to effectively guide CGM use in OBGYN practice, from preconception and PCOS to pregnancy and perimenopause. They highlight the importance of interpreting data trends, setting realistic glucose targets, and supporting patients through the practical and emotional challenges of CGM use.

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Timestamps

00:00 - Introduction
04:58 - CGMs in Women’s Health
07:33 - OTC Data Sharing Issues
09:52 - Pregnancy Glucose Targets
16:20 - Accuracy and Variability
20:10 - Anxiety and Eating Disorders
24:41 - Counseling and Follow-Up
28:29 - Prescription and OTC CGM Picks
37:24 - False Lows and Sensor Errors
41:23 - Alarm Settings and Logging
44:06 - Interpreting Metrics and Limits
46:44 - Provider Dashboards
48:42 - Final Thoughts

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More about this episode

Given the lack of well-established blood glucose targets outside of type 1 diabetes, Dr. Canelo reviews commonly used ranges for individuals without diabetes, those with prediabetes, and pregnant patients with type 1 or 2 diabetes. He explains how to interpret CGM data, including the time in tight range, coefficient of variation, and the importance of focusing on overall trends rather than isolated glucose spikes. They also discuss the potential drawbacks associated with CGM use, including anxiety and eating-disorder risks. Practical considerations include sensor inaccuracies, false lows readings, and optimizing alarm settings. Dr. Canelo emphasizes the importance of having patients log meals and other events while wearing the sensor and scheduling follow-up after the initial 15-day wear period to ensure accurate interpretation and effective counseling. Finally, they compare OTC and prescription CGM options, including costs, clinician access to patient data, and insertion tips.

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Resources

Stelo - Over the Counter CGM Option
https://www.stelo.com/en-us

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Are you building a business that can thrive without you, or just creating a job you can never leave? In this episode of BackTable Women’s Health, host Dr. Karen Toubi sits down with Dr. Nneka Una (Unachukwu), a board-certified pediatrician, founder of Ivy League Pediatrics, and creator of EntreMD, to discuss the mindset and skills needed to build a truly sustainable medical practice. The conversation explores why physician entrepreneurship is essential in today’s evolving healthcare landscape, the difference between building yourself a job and building a resilient business, and practical strategies for long-term growth.

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Timestamps

00:00 - Introduction
04:47 - From Employee to Owner
05:53 - Skills That Changed Everything
07:35 - The Wake Up Call
10:44 - Why Doctors Resist Business
15:06 - Profit as Patient Care
18:20 - Job vs. Business Entity
21:13 - CEO Hat and Team Systems
25:14 - Exit Value and Sellability
29:00 - More Profit: More Time Off
30:24 - Fear Before Breakthrough
35:32 - Choose Service Over Perfection
39:11 - Invest in Your Potential
46:26 - MEAT Week Priorities
48:40 - Three-Part Daily Rhythm
55:02 - Advice for Burned-Out Docs
59:29 - Wrap Up

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More about this episode

Dr. Una shares how doctors can overcome resistance to “business,” why every practice needs a strong business engine, and how to balance profitability with ethical, people-centered care. She explains how to shift from employee to physician-CEO, tackle imposter syndrome, and develop systems that give your practice true staying power. The discussion provides actionable advice on hiring, team management, building exit value, and creating the freedom to take more time off without sacrificing patient care or financial stability.

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Resources

EntreMD https://entremd.com/about-us/

The Profitable Private Practice Playbook https://entremd.com/method-book/

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Lower C-section rates, faster deliveries, and less physician burnout: could the OB hospitalist model deliver all three? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Maliha Sayla, a board-certified OBGYN and medical director of labor and delivery at Northwestern Medicine Delnor Hospital, to explore how the OB hospitalist model is reshaping care for physicians, patients, and healthcare systems.

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Timestamps

00:00 - Introduction
03:27 - Why Hospitalists Matter
05:33 - How Their Model Works
07:15 - Managing Pushback
10:18 - Measuring Better Outcomes
15:58 - Drills and Emergencies
19:50 - Staffing and Transition
24:33 - ROI and OB-ED
26:33 - Residents and Teaching
30:52 - Future Flexible OB Careers
34:14 - Patient Acceptance of Model
36:47 - Collaboration and Lifestyle Balance
40:00 - Conclusion

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More about this episode

Dr. Sayla shares her journey from traditional private practice to full-time OB hospitalist work, explaining how this model reduces physician burnout by making labor and delivery a dedicated role rather than one juggled alongside clinic visits, surgeries, and administrative responsibilities. She details her institution’s staffing structure, where hospitalists provide continuous labor and delivery coverage, allowing generalist OBGYNs to focus on outpatient care. Dr. Sayla highlights the benefits of having dedicated physicians available for bedside counseling, fetal monitoring, and real-time decision-making. The episode explores improvements in communication, collaboration, and patient outcomes, including lower NTSV (Nulliparous, Term, Singleton, Vertex) cesarean rates and shorter induction-to-delivery times after adopting the hospitalist model. Additionally, she discusses the hospitalist role in obstetric emergency preparedness and interdisciplinary collaboration, patient perspectives, and the potential of hospitalist programs to address OBGYN workforce shortages.

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Get an inside look at prolapse surgery, from technique to training to team-based care. In this episode of BackTable Women’s Health, Dr. Amy Park talks with Mayo Clinic urogynecologist and pelvic reconstructive surgeon Dr. John Occhino about the art and strategy behind prolapse repair. They explore why Dr. Occhino favors vaginal approaches, when robotics come into play, and how he frames staged treatment strategies, particularly for younger patients at risk of recurrence.

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Timestamps
00:00 - Introduction
02:09 - Choosing Vaginal vs. Robotic Approach
10:24 - Why Vaginal Skills Declined
13:20 - OR Setup and Positioning
16:32 - Anterior Entry Technique
20:05 - Ureter Safety and Suspension
28:14 - Robotic Hysteropexy Considerations
31:47 - Collaborative Training Culture
35:41 - Beyond See One Do One
46:13 - Anatomy Keeps You Safe
49:46 - Leadership Authenticity
53:45 - Team Support and Wrap Up

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More about this episode
The conversation covers how to counsel patients about prolapse as a dynamic condition, the trade-offs between durability and mesh aversion, and the importance of prioritizing symptoms and quality of life in decision-making. They share practical tips on vaginal hysterectomy technique and ergonomics, discuss why vaginal surgery skills are declining, and highlight best practices in surgical education, including apprenticeship-style training, promoting psychological safety, setting targeted goals, fostering collaboration among program directors, and grounding surgical judgment in anatomy and authenticity in leadership.

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
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Can a “normal” pelvic exam mask life-altering pain? On this episode of BackTable Women’s Health, host Dr. Karen Toubi interviews board-certified OBGYN Dr. Chailee Moss about why common vulvovaginal pain and skin conditions are frequently missed or dismissed as “normal” exams. Dr. Moss explores how gaps between gynecology and dermatology, limited training, and the under-recognition of non-life-threatening but highly morbid pain contribute to these diagnostic challenges, including mental health impact and even suicidality in some cases.

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Timestamps

00:00 - Introduction
03:56 - Why Pain Gets Missed
08:58 - Building Trust With Time
10:51 - Vulvodynia Workup Basics
16:02 - Hormonal Vestibulodynia Clues
21:21 - New Treatments On Horizon
23:07 - Lichen Steroid Maintenance
26:25 - Biopsy Decisions And Mimics
30:30 - Multimodal Treatment Planning
33:00 - Pelvic Floor PT Done Right
35:55 - When To Consider Surgery
37:33 - Clinical Trials Ketotifen Botox
40:40 - Conclusion and Resources

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More about this episode

They discuss rebuilding trust through time, attentive listening, and clear communication, along with a detailed evaluation process that includes medication review, targeted symptom questions, Q-tip mapping, vulvoscopy, cultures, and selective biopsy. The approach informs an individualized, multimodal treatment plan. Additional topics include lichen steroid counseling,differentiating mimickers like yeast and irritant dermatitis, and connecting patients to resources such as ISSWSH, ISSVD, and support groups.

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Resources

Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711

ISSWSH

https://www.isswsh.org/

Pudendal Hope

https://www.pudendalhope.info/

Tight Lipped

https://www.tightlipped.org/

The National Vulvodynia Association

https://www.nva.org/

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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How do you decide which noninvasive prenatal testing option is best for your patient, and when should you reach for single-gene NIPT? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews maternal-fetal medicine specialist Dr. Andrei Rebarber to break down the evolving world of prenatal genetic testing. They discuss the importance of pan-ethnic carrier screening, the clinical scenarios where single-gene NIPT is most useful, and how to navigate counseling and follow-up for a wide range of patients.

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This podcast is supported by

Natera
https://www.natera.com/info/fetal-focus

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Timestamps

00:00 - Introduction
04:43 - Prenatal Genetic Testing Basics
07:10 - Larger Panel Screening Benefits
10:49 - Defining Single-Gene NIPT
14:51 - Counseling and Invasive Options
18:26 - Accuracy Data and No Call Rate
22:03 - Patient Acceptance of Test
24:18 - When to Test and Screen
26:13 - Counseling Carrier Results
30:12 - In Utero Treatment
32:36 - Workflow for Generalists
35:33 - How to Interpret Literature
40:08 - Closing Remarks

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More about this episode

Dr. Rebarber shares how witnessing in-utero transfusions for severe Rh disease inspired his career in OBGYN and maternal-fetal medicine, highlighting the importance of treating the fetus as a patient and the rapid growth of fetal therapy. The episode reviews ACOG-guided carrier screening for conditions like cystic fibrosis and hemoglobinopathies, the trend toward larger, pan-ethnic screening panels, and why carrier findings are common but true “double-carrier” couples are relatively rare. Dr. Rebarber also discusses the clinical utility of single-gene NIPT—a cell-free placental DNA test for select recessive conditions—especially when partner testing isn’t possible or when patients wish to avoid invasive procedures. The conversation compares screening and diagnostic strategies, including CVS and amniocentesis, and provides practical insight into interpreting test performance and emerging research.

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Resources

EXpanding Prenatal Cell Free DNA Screening Across moNogenic Disorders (EXPAND)
https://clinicaltrials.gov/study/NCT06808880?tab=study

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Osteoporosis may present after menopause, but prevention starts decades earlier. In this episode of BackTable Women’s Health, Dr. Carla Gunn, guest host and OBGYN, interviews Dr. Pooja Luthra, an endocrinologist at UConn Health, about osteopenia, osteoporosis, and practical strategies for lifelong bone health.

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Timestamps

00:00 - Introduction
03:28 - Why Bone Health Matters Early
05:23 - Bone as a Vital Sign
08:02 - Amenorrhea and Early Screening
09:51 - Calcium, Vitamin D, and Protein
15:11 - Menopause Bone Biology Explained
21:58 - Metabolic Diseases and Bone Risk
25:58 - Early Screening Red Flags
27:53 - Hormone Therapy Bone Benefits
30:59 - Reading DEXA Scores
33:42 - FRAX Scores
35:09 - Modern Treatment Sequencing
38:02 - Bisphosphonates Mechanism and Concerns
41:16 - Secondary Labs and Referrals
44:23 - Closing Thoughts

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More about this episode

Dr. Luthra explains how peak bone mass is largely established by early adulthood, followed by accelerated loss during the perimenopausal/menopausal transition due to estrogen decline, inflammatory cytokines, altered calcium absorption, and increased bone resorption. She reviews prevention strategies, including adequate calcium, vitamin D, and protein intake, resistance training, and avoiding smoking and excess alcohol use. The discussion also covers high-risk conditions that can negatively impact bone health, including amenorrhea, premature ovarian insufficiency, hyperthyroidism, diabetes, and chronic kidney disease, along with considerations for earlier screening in these patients. Dr. Luthra walks through DEXA interpretation, including T-scores, Z-scores, trabecular bone score (TBS), and FRAX assessment. She closes the conversation by outlining treatment sequencing with anabolic agents before antiresorptives, bisphosphonate safety, alternative therapies, and secondary osteoporosis workup labs.

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Resources

FRAX Tool:
https://www.fraxplus.org/calculation-tool

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app