Gyno Girl Presents: Sex, Drugs & Hormones

Menopause care is changing, and what you hear at your next appointment may change with it.

In this solo episode, I share what I took away from the Menopause Society meeting in San Diego.

There was a lot to be encouraged by, including new guidance from ACOG, the American College of Obstetricians and Gynecologists, and a health advisory from the American Heart Association on how reproductive life stages connect to heart health.

There were also mixed messages about hormone therapy that may have left some clinicians unsure what to take back to their patients.

I go through what has changed and what is still uncertain, and I share why I am encouraged about where menopause care is headed and what you can ask for at your next appointment.

• What I took away from the Menopause Society meeting, including the mixed messages about hormone therapy.
• What ACOG’s new guidance says about hormone therapy for hot flashes and night sweats, and why timing matters.
• The non-hormonal options for women who cannot or choose not to take hormones.
• Why the American Heart Association advisory points to perimenopause as an important time for heart health, especially for South Asian women.
• What the new guidance does not cover, including sexual health.
• What to ask at your next appointment, and how tracking your symptoms can help.

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If you haven’t tuned in recently or this is your first time listening, I launched my book and have been on tour promoting it. One of the chapters getting the most engagement is Chapter 3, Sex and Culture for Brown Girls, so in this solo episode I read a portion of it. It looks at how sex was viewed in South Asia and other parts of the world before colonial rule, when sexual pleasure was written about openly in religious texts, medical books, and art, and how British colonial rule and Victorian ideals are part of that story. I also share how the launch has gone and how the book is organized.

What You’ll Learn

• How the book launch and tour have gone so far, and where I’m headed next.
• Why I chose the title Brown Girls Disease, and why culture is context, not a diagnosis.
• How the book is organized, from the foundations of anatomy and culture to the most common sexual health concerns and the conditions that complicate them.
• A reading from Chapter 3, Sex and Culture for Brown Girls.
• How history, religion, and colonialism shaped attitudes toward sex across South Asia and beyond.
• How long-term stress can wear on the body, and why it matters for health.

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Join me as I sit down with Dr. Natalie Crawford, a reproductive endocrinologist and the author of The Fertility Formula. We start with what women should understand about their bodies before they try to get pregnant, which includes knowing what is going on with their ovaries and hormones.

Natalie weighs in on one of the more recently discussed questions in fertility: should an IUD come out before you start building your family?

Natalie shares what she and other fertility doctors are seeing in women who have had a progesterone IUD for years, and why she suggests taking it out about six months before you start trying. We also talk about how far egg freezing has advanced and how much better the results have become.

Along the way, Natalie shares what an AMH test can tell you about your ovarian reserve and the timing of perimenopause, and how inflammation and lifestyle can influence your ovaries.

• What to understand about your body, including your ovaries and hormones, before you try to get pregnant.
• The debate over taking out an IUD before you start trying.
• How far egg freezing has advanced, and what it can and can’t promise.
• What an AMH test can tell you about your ovarian reserve and the start of perimenopause, and why it isn’t a menopause test.
• Why symptoms can get written off as perimenopause.
• How infertility and earlier menopause show up for women of color.
• How to choose a fertility clinic, and when to get a second opinion.

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Menopause is biologically universal, but how women experience it, and whether they even have a word for it, depends a lot on where they live.

I talk with Dr. Yewande Banire, a family nurse practitioner who cares for patients in the United States and in Lagos, Nigeria, about what women's health looks like through an international lens. Yewande shares how her own years of heavy periods and fibroid pain, and being told it was just part of being a woman, led her into this work.

We talk about why women in Nigeria may not have a name for hot flashes or night sweats, how those symptoms can be mistaken for malaria or typhoid, and what limited access to hormone therapy looks like in practice.

We also get into the role a husband's permission can play, early ovarian insufficiency in women under 40, and what birth control pills can offer when hormone therapy isn't available. Yewande closes with a message for patients and for clinicians.

• Why perimenopause and menopause can feel like a "this is not a problem we have" in places where no one is talking about them.
• How symptoms like joint pain and night sweats get treated as other issues when menopause is the missing piece.
• What limited access to estrogen and progesterone means for women who can't easily get or afford them.
• How some cultures have stigma around age, and how a husband’s approval can shape whether women seek care for libido and vaginal dryness.
• What clinicians can do to meet patients where they are, and why it's okay to refer when you don't know.

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Seven years ago, I started keeping notes on patient stories I kept coming back to, including a woman who hadn't been able to have sex in seven years, and a 68-year-old cancer survivor who wanted her life back. Somewhere along the way, I ended up writing about myself too, including something I've never told you before. Those stories became my new book, Brown Girls' Disease?, out October 6th. The title comes from a term I once heard used in a hospital to dismiss South Asian women with vaginismus, and I'm reclaiming it. Culture, religion, and ethnicity do shape how we experience sex, but they're context, not a diagnosis, and this book is for anyone who's ever been dismissed, not just South Asian women.

Highlights:

• Why "Brown Girls' Disease" was originally a dismissive hospital term, and why I'm reclaiming it for a book meant for everyone.
• The patient stories behind the book.
• A personal story about my own experience with vaginismus that I've never shared publicly before.
• Why culture, religion, and shame shape how we experience sex, and why that context matters without becoming a diagnosis.

• October 6 — New York City (book pub day)
• October 8 — Chicago, IL (The Veronica Beard)
• October 15 — Charlotte, NC (hosted by Dr. Sasha Davenport)
• October 17 — Worcester, MA (UMass OBGYN Department 50th anniversary)
• October 18 — Menopalooza, Chicago, IL (with Midlife Upgrade
• October 20 — Los Angeles, CA (The Womb)
• October 21-24 — San Diego, CA (The Menopause Society annual meeting)
• October 25 — Cleveland, OH (bookstore event, plus a lunch and learn at the OBGYN/Sexual Medicine department the following day)
• October 28 — Oak Brook, IL (The Book Loft, book signing) ■
• November 11-15 — ISSWSH Fall Course
• December 10 — Palo Alto, CA

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Dr. Jim Pfaus is a behavioral neuroscientist who has spent decades watching rats have sex to understand what's happening in the brain during desire, arousal, and orgasm.

I talk with Jim about what that research can teach us about our own desire, and just how much of it comes down to the brain rather than any one hormone. We tend to assume females have little say in when sex happens, but Jim's research shows the opposite in female rats.

They have complete control over whether it happens at all.

He also shares a study on partner preference: when a male rat has to wait for one specific female instead of getting instant, easy access to her, he'll seek her out over other females afterward. When there's no wait, that preference never forms.

We also get into what dopamine and serotonin are doing during arousal and orgasm, why SSRIs can shut down desire and what can sometimes be adjusted, and the real relationship between testosterone and estrogen in both men's and women's bodies.

Jim also explains what might be happening in the brain when GLP-1 medications affect libido, the inverted U-shaped curve behind arousal and performance, how early experiences condition what turns us on for life, why pain responses in conditions like PGAD and vestibulodynia are so hard to fully unlearn, and what his research suggests about psychedelics and sexual connection.

• Why sex is a behavior generated by the brain, not just a matter of hormone levels.
• What decades of studying rat sexual behavior reveal about desire and consent, including how female rats have complete control over whether sex happens.
• Why male rats only form a preference for a specific partner when she isn't simply available on demand, and what that suggests about waiting and anticipation.
• How dopamine drives attention and wanting, and why it drops sharply after orgasm.
• What serotonin does to desire and orgasm on SSRIs, and how dosing can sometimes be adjusted.
• The real relationship between testosterone and estrogen in both men's and women's bodies.
• What might be happening neurologically when GLP-1 medications affect libido.
• The inverted U-shaped curve, and why some people need more stimulation while others need less.
• How early sexual experiences can condition lifelong arousal patterns.
• Why pain responses like PGAD and vestibulodynia are so difficult to fully unlearn, even after the physical cause is treated.

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A lot of women notice their desire for sex fading over time and assume something is wrong with them, but there's often a real reason for it, and they're not the only ones going through it.

I sat down with Dr. Lori Brotto, one of the most recognized researchers in women's sexual health, to talk about why desire changes and what actually helps bring it back. We discuss the difference between spontaneous and responsive desire, how to tell low desire apart from asexuality, and how sensate focus works in sex therapy.

Lori also introduces eSense, her mindfulness and CBT based digital platform built to close the access gap for women who can't reach a sex therapist, and shares surprising research on how an AI-powered navigator stacks up against a human one.

• How to differentiate low desire (a treatable concern) from asexuality (a sexual orientation).
• What sensate focus actually is and how it's used in sex therapy.
• Why sexless relationships often start with avoiding non-sexual touch, not sex itself.
• What mindfulness and CBT do as treatments for low desire.
• The origin and design of eSense: a self-directed digital program modeled on real sex therapy sessions.
• The risks of unregulated AI (like general chatbots) in mental health contexts, and how eSense was trained differently.
• Access, translation, and the biopsychosocial barriers facing racialized and non-English-speaking women.
• Technoference: how technology disconnects us in daily life, and how it can also be used to rebuild presence.
• A live guided mindfulness exercise listeners can follow along with.

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We talk a lot about screening and treatment in the breast cancer space. What we do not talk about nearly enough is what happens after. What happens to a woman's fertility, her vagina, her relationships, her body image, her mental health, her cardiovascular health, and her sense of self when treatment ends and everyone expects her to simply be grateful to be alive.

Dr. Eleonora Teplinsky is a board certified medical oncologist specializing in breast and gynecologic cancers, head of breast and gynecologic medical oncology at Valley Health System, and author of the new book Beyond the Pink: Navigating Life, Health, and Breast Cancer. Her work has long focused on young women with cancer, sexual health, and survivorship. And this book is her answer to a question medicine has not been asking loudly enough: how do we help women not just survive but thrive?

We cover a lot of ground. Hormone therapy after breast cancer, including the nuanced conversations around hormone receptor positive versus negative disease, vaginal estrogen, testosterone, and Duavee. Bone health, body composition, sarcopenia, and the emerging data on GLP-1 medications and breast cancer recurrence risk. The difference between a local and distant recurrence and what ongoing screening actually looks like years after treatment.

We also discuss the racial disparities in breast cancer care that begin with clinical trial enrollment and run all the way through treatment decisions, drug access, and who gets believed when they report pain. The medical distrust that Black women carry into the oncology office for very good reason. And what it means to practice truly patient centered care when the healthcare system was not designed to make that easy.

Survivorship does not begin when treatment ends. It begins at diagnosis. And you are more than your breast cancer.

Highlights:

• Vaginal estrogen is safe for the vast majority of breast cancer survivors, including those on aromatase inhibitors.
• Testosterone may actually act as a tumor suppressor in hormone receptor positive breast cancer.
• GLP-1 medications show early signals toward lower breast cancer recurrence risk.
• Black women are underrepresented in clinical trials and undertreated in guideline-based therapies.
• Survivorship care starts at diagnosis, not when treatment ends.
• Bone density should be checked right after chemotherapy; weight-bearing exercise, calcium, vitamin D, and body composition monitoring are all part of survivorship care.
• Black women are underrepresented in clinical trials, undertreated in guideline-based therapies, and underbelieved when reporting symptoms; medical racism in breast cancer care is real and documented.

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Many of the women I see in my practice are dealing with gut issues that connect directly to their hormones, and this week I finally got to dig into all of it with someone who truly lives at that intersection.

Dr. Kumkum Patel is a board certified gastroenterologist who did a subfellowship in neurogastroenterology and motility and now runs her own private practice focused on IBS and the gut brain connection. Before she was a doctor she was a patient, and her personal journey through infertility, postpartum depression, and pelvic floor dysfunction as a first year fellow is what shaped everything about how she practices today.

We start with the gut brain connection, what the enteric nervous system actually is, why the gut is sometimes called the second brain, and how 70 to 80% of our happy hormones are made right there in the gut. From there we get into how stress, whether from childhood trauma, a stressful job, or the hormonal chaos of perimenopause, disrupts that entire system and shows up as bloating, constipation, diarrhea, and IBS.

We talk about the estrobiome, the specific gut bacteria responsible for regulating estrogen, and what happens when that balance is off. We cover why perimenopause causes constipation from three different directions at once, why leaky gut is a real phenomenon even if the wellness industry has run away with the term, and what actually works when it comes to treating IBS.

We also had a lot of fun with a rapid fire myth busting round at the end covering everything from gut cleanses to probiotics to how often you should actually be pooping.

This is the gut health conversation midlife women have been waiting for.

• 70 to 80% of your serotonin is made in your gut, not your brain.
• The gut is a self cleaning organ you do not need a cleanse.
• Perimenopause affects your gut from three directions at once.
• Normal bowel movements ranges from 3 times a day to 3 times a week
• Probiotics are all about knowing what strain is in them.
• Leaky gut is real, even if the wellness industry has run away with it.
• Childhood trauma can show up decades later as IBS or chronic constipation.

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Dr. Kudzai Dombo is a board certified OBGYN, educator, and one of the leading voices in elevating conversations around women of color and their healthcare journey.

We start with the SWAN study, a 25-year longitudinal multiracial, multi-ethnic cohort study that enrolled over 3,300 women between the ages of 42 and 52. It remains one of the most important sources of information we have on how menopause affects women differently across racial and ethnic groups. What it found is striking: Black women are more likely to experience worse vasomotor symptoms, their hot flashes last on average 10 years compared to 6.5 for white women, and they tend to enter menopause about 1.2 years earlier. Hispanic women also enter the menopausal transition earlier, with symptoms lasting on average about 9 years. These are not small differences.

We talk about why these disparities exist, including the concept of weathering, the chronic stress load carried by Black women navigating systemic racism that accelerates biological aging, and what allostatic load actually means in the body. We get into social determinants of health, what they are, how they shape who gets equitable care and who does not, and why implicit bias is not a character flaw but a phenomenon every clinician needs to examine continuously.

We also get personal. Dr. Dombo shares what it felt like to be on the other side of the system she works within, and we talk honestly about what patients can do when they feel dismissed, and what clinicians can do before they even walk into the room.

This is a conversation about science, equity, and advocacy. And it is one every woman and every clinician needs to hear.

• The SWAN study, established in 1996, followed over 3,300 women for 25 years and remains the most comprehensive source of data on racial and ethnic differences in the menopause experience.
• The SWAN study found that Black women slept on average 30 minutes less per night than white women, even though they were less likely to report sleep disturbances — a gap that has significant implications for cardiometabolic health.
• Weathering is the concept that chronic stress from navigating systemic racism accelerates biological aging in Black women, contributing to earlier and more severe menopause symptoms and higher cardiometabolic disease burden.
• Social determinants of health include economic stability, access to quality care, food environments, green spaces, and the chronic stress of racial discrimination — all of which shape health outcomes.
• Only 6.8 percent of US residents felt prepared to prescribe hormone therapy at graduation a statistic that explains a great deal about the care gap women experience.
• Hot flashes are not benign; the intensity and duration of vasomotor symptoms is linked to cardiovascular risk and brain health, which makes treating them a priority not a preference.

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