Feeling Like Yourself Again: Women's Health with Dr. Rachel Novik
00:41
Welcome back to In Her Land, where we have honest conversations with women who are shaping their communities, leading meaningful lives, and navigating all the twists and turns that come with being a woman. I'm Mara Kamat.
01:13
Carrie Aguilar
And I'm Carrie Aguilar. One of the things we hear over and over from women, whether they're CEOs, educators, entrepreneurs, mothers, or community leaders alike, is that they spend so much time caring for everyone else that they often put themselves at the bottom of the list. And eventually, our bodies have a way of reminding us that we can't do that forever.
01:34
Mara Kamat
Today's conversation is one that's deeply personal because it's a conversation that so many women are having. And it's about our health. Right. As we're scrolling the Internet at night, we're trying to figure out, is this normal? Why am I suddenly exhausted? Why can't I sleep? Why.
01:51
Carrie Aguilar
Am I exhausted and yet still can't sleep? That's like my main ask into Instagram every night.
01:57
Mara Kamat
Is this perimenopause? I'm hot. Is this.
02:01
Carrie Aguilar
The end of the world? Does Apocalypse look like this?
02:05
Mara Kamat
So today we're talking about women's health, menopause prevention, and how to advocate for ourselves at every stage of our life. I'm so excited that I'm joined here with Dr. Rachel Novick, who is also my sister in law. Welcome, Rachel.
02:21
Dr. Rachel Novik
Thanks for having me, guys.
02:23
Carrie Aguilar
We're really excited to have you.
02:25
Mara Kamat
Rachel is a physician at the Cleveland Clinic who specializes in women's health, menopause care, sexual health, contraception, and osteoporosis management. Before we get into all of that, Rachel and I have known each other for 25 years. I did the math, Rach. More than 25 years. Wait,.
02:45
Carrie Aguilar
So you met her when she was 10 years old?
02:47
Dr. Rachel Novik
Yeah.
02:48
Carrie Aguilar
Wow.
02:48
Dr. Rachel Novik
Yeah.
02:49
Carrie Aguilar
That's incredible.
02:50
Mara Kamat
Yeah. And what's been really incredible for me is to Have a front row seat in growing together and being on this journey together and seeing you become a physician and then doing a fellowship at Cleveland Clinic and women's health and now becoming a doctor. So I'm excited to have you on the podcast today.
03:08
Carrie Aguilar
And now you have our own speed dial for every question that you have.
03:12
Mara Kamat
And that is.
03:12
Carrie Aguilar
And now, Rachel, I have you on speed dial. So I'll be. Instead of asking Instagram every night, why am I so exhausted and yet cannot sleep? I'll just be calling you. Is that okay?
03:22
Dr. Rachel Novik
Yeah, I'll be up exhausted and awake as well.
03:27
Carrie Aguilar
I love that. Before we jump into all of the questions women are asking about menopause and hormones, we always like to start with the person behind the title. Tell us a little bit about your journey. What drew you to medicine and what ultimately led you to focus on women's health?
03:43
Dr. Rachel Novik
Well, that was a very roundabout way to get to medicine for me. I went to NYU for undergrad with the plan to get a degree in social work.
03:53
Carrie Aguilar
Oh, wow.
03:54
Dr. Rachel Novik
Yeah. So I have a bsw. And while I was there, I was taking child and adolescent mental health classes run by psychiatrists. So I was like, oh, that's what I want to do. I want to be them. I don't want to be a social worker. Not that there's anything wrong with social work, but as I went through time, I was like, I don't want case management. I want the one one interaction and care. And so I decided in that moment, I was going to apply to medical school. So.
04:22
Carrie Aguilar
Wait, after. But after you got your bsw.
04:25
Dr. Rachel Novik
So I decided during school, I was like, oh, these are the people that I think I actually want to be, which was a pediatric psychiatrist, not a women's health specialist. So there's a separate. Separate thing there, too. But. So I. But I hadn't taken a science class. I didn't have to take biology, so I had to come back home. And I did an additional two years at John Carroll doing all my science classes. And I worked at Belfair for two years while I was.
04:52
Carrie Aguilar
Doing. My mom was on the board of Belfair. So how was your experience at Belfair?
04:56
Dr. Rachel Novik
It was great. It was great. I worked in their autism residential program, and by the time I finished school and finished that, I was like, I'm tired. This is harder than I thought it would be. And I was like, I don't have the mental health stamina for this. I'm not as strong as I thought I was. And so I was like, well, I'VE already gotten into medical school. I don't think this is what I am gonna end up doing. But we'll see. You know, it's too late now is how I felt. Not in bad.
05:24
Carrie Aguilar
Way in medical school when you start, and correct me if I'm wrong, because obviously you're a doctor and I'm clearly not. You don't have to declare what you want to do. You just want to be a doctor there. So it's not like you really walk too far down the.
05:35
Dr. Rachel Novik
No, not at all. But I was like, oh, this is not quite. This beautiful picture I thought I was going to have was still not quite right.
05:41
Carrie Aguilar
Yeah.
05:41
Dr. Rachel Novik
So then I did it as process of elimination.
05:44
Carrie Aguilar
Okay.
05:45
Dr. Rachel Novik
So I actually was like, ob gyn. This is it, babies. And then I did my OB GYN rotations, and.
05:52
Carrie Aguilar
No.
05:53
Dr. Rachel Novik
Yeah. Like, the first day, I was like, I don't think I'm gonna have children. I don't. This is it. I'm done. This is.
05:58
Carrie Aguilar
A bloodbath.
05:59
Dr. Rachel Novik
I. Well,.
06:00
Mara Kamat
Literally, it.
06:01
Dr. Rachel Novik
Was. Yeah. I watched a forceps delivery. I watched a vacuum delivery. I watched an emergency C section, and I was like, that's it.
06:08
Carrie Aguilar
You're like, next. You're like, plastics is for me.
06:13
Dr. Rachel Novik
And it was just a series of, okay, this isn't it. This isn't it. Like, what is my personality? I don't know. So I ended up in family medicine, which I think was the right fit. Listening to people, doing a lot of just helping to navigate what is the right answer. But family medicine's also tough. I liked the preventative health portion of primary care, but not the sick portion. Yeah. The hypertension, the diabetes, that. I have a sinus infection and I want antibiotics now. I didn't like that part, and so I did more digging, and I was like, what am I actually passionate about? And women's health was where I ended up. And it started off more as contraception and birth control and that piece of it. And then I found out this fellowship existed.
07:00
Carrie Aguilar
Were you like, hey, listen, I've seen the other side. I did a rotation. Yeah,.
07:04
Dr. Rachel Novik
I did one rotation, and.
07:05
Carrie Aguilar
I'm gonna help.
07:06
Dr. Rachel Novik
You. One time. Yes, that was it. But I was like, okay, yeah, look, it was horrifying. I wish that on no one.
07:13
Carrie Aguilar
So, wait, so where do. So to round it out, where did you go to med school? Cause I had two med schools,.
07:19
Dr. Rachel Novik
So. Ohio University's South Point campus. So here in Cleveland.
07:23
Carrie Aguilar
Very cool.
07:24
Dr. Rachel Novik
Yeah.
07:25
Mara Kamat
And then you applied for your fellowship at Cleveland Clinic.
07:27
Dr. Rachel Novik
Then I did residency in family medicine. And then I applied to fellowship at the clinic,.
07:32
Carrie Aguilar
And that was for women's health. And now.
07:34
Dr. Rachel Novik
You're. That was specifically for. They call it a specialized women's health fellowship for complex hormone care. So if you. As we're seeing now, there's no. There hasn't been any attention on women's health, preventative health, any of. Yeah. And so it was just an unneeded place, and now it's blown up and here we are.
07:55
Mara Kamat
What I think is unique, and you didn't really talk about it yet, but I think it's a great thing for women to hear is even during this time, you were also having bab. So when did you have your children in relation to finishing your residency and then doing fellowship?
08:12
Dr. Rachel Novik
So I had Ellie during third year of residency, beginning of third year, end of second year. So I'd gotten all of my majority of my hospital rotations done with, so I had a little bit of an easier schedule. And then. And then I had Gabriel, second year fellowship. So both during training, but.
08:33
Carrie Aguilar
So you were busy.
08:34
Dr. Rachel Novik
Just a little,.
08:35
Carrie Aguilar
And you had kids, which made you busier.
08:37
Mara Kamat
Yeah.
08:38
Carrie Aguilar
That's wonderful.
08:39
Mara Kamat
But I think it's always nice to talk about with women and for other women, because we always look at it, we're like, how do we do it all? Can I be a doctor and go to med school? And you're unique in the sense too, that you did your four years and then you took another two years to do a post bacc and then apply to medical school. So you were also an older med student than typical. And I think that is very courageous of you that you still chose to go down that path, even though that might not have been like the easiest, most linear path at the time.
09:09
Carrie Aguilar
Oh, I will. Just a second. I don't even know you. And I'll snaps to that because. No, but it's so true. Because you walk down a path that looks like NYU is impossible to get into, and that's a commitment. Right. And then social and being able to make the decision. Okay, I know that this isn't the right path for me. What is the right path?
09:26
Dr. Rachel Novik
And I made that decision even though I couldn't change anything. Yeah,.
09:29
Carrie Aguilar
Exactly. Like, you're like,.
09:30
Dr. Rachel Novik
I still fish that degree and I still, you know, if I did it all again, would I do the same thing? Probably not. But you get where you get. Yeah, exactly.
09:39
Carrie Aguilar
So, Rachel, I think I told you what my usual late night Instagram question is, which is why am I exhausted and still cannot sleep? I feel like in the same vein, women's health has really. Or the focus on women's health has really exploded recently. Many women, they're stressed, they're overwhelmed, they're aging. They feel like they're doing something wrong. Why do you think we're finally having more open conversations about women's health? Menopause, perimenopause.
10:12
Dr. Rachel Novik
Honestly, I think social media is, like, the big answer. Like, why are we having these conversations? Because people are actually willing to talk about them, and our generation is not happy with the way we're getting treated. Frankly, I think that's why it's happening. I think historically, hormones and menopause and perimenopause, it was like, only if you are so miserable should you go on this. Right? And now it's no. I just want to feel good. I want to feel like myself again. And that push to just be able to go back to the life you had is real.
10:44
Mara Kamat
Yeah. For me, I really appreciate the fact that I feel less alone when I, like, hear some of the stories and hear how other women feel. Because sometimes I'm like, why am I so tired? Why do I have brain fog? And part of it is the lack of sleep. But then digging deeper, why am I not sleeping? So in the spirit of that, talk to us a little bit about what is the difference between menopause and perimenopause? How should we look at these things?
11:08
Dr. Rachel Novik
Yeah. So I think menopause is very black and white. Perimenopause is like, when are you having symptoms? I keep it vague. Do you have symptoms? Okay. Are your periods changing? Okay, you're probably perimenopausal. Don't overthink it. Because if you have symptoms and you're coming to see me, it's obviously bothering you enough that you want to do something about it.
11:28
Carrie Aguilar
And can you define symptoms for someone?
11:31
Dr. Rachel Novik
Symptoms so can be hot flashes, night sweats, vaginal dryness, pain with intercourse, urinary frequency, urgency, brain fog, fatigue, joint pain, dry skin.
11:43
Carrie Aguilar
Oh, cool. So literally everything.
11:45
Dr. Rachel Novik
Literally everything. Dry eyes, ringing in your ears.
11:48
Carrie Aguilar
Do I call for an appointment now, or can I just get on your calendar? I'm.
11:52
Dr. Rachel Novik
Here.
11:52
Carrie Aguilar
One thing I've learned is that many of us think menopause is just hot flashes. Can you break down what menopause really is?
12:00
Dr. Rachel Novik
Yeah. So menopause. Menopause is 12 months without a period. That is how we define it.
12:05
Carrie Aguilar
Oh,.
12:06
Dr. Rachel Novik
I had.
12:07
Carrie Aguilar
No.
12:07
Dr. Rachel Novik
Idea. It's a retrospective. Oh, you have symptoms. Now you're perimenopause. Oh, now you've gone 12 months. So you went through menopause a year ago. It's just a label. Don't. Again, I always think. Don't overthink. It.
12:18
Carrie Aguilar
Literally is just like you stopped your period.
12:20
Dr. Rachel Novik
You stopped your period and you've gone a year without it.
12:22
Carrie Aguilar
And not.
12:23
Dr. Rachel Novik
For a medical reason like an IUD or surgery or whatever that would be.
12:29
Carrie Aguilar
And is perimenopause. I know it comes before menopause, but is it. Are there ages where people typically hang out or.
12:36
Dr. Rachel Novik
Right, so that's. It's a transition period. So historically, we say seven years is the perimenopause transition. That's old data, though. I think that again with our generation people, we're going to find that perimenopause hormone fluctuation transition is much longer because people are reporting symptoms. And so I think we'll find that it's longer. But that's just my own personal guess. But historically, seven years from symptom onset to symptoms end. And in between that time, right? No, not end.
13:11
Carrie Aguilar
Oh, just kidding.
13:12
Dr. Rachel Novik
Yeah. And in between that point, at some point, you stop having your period, and then hopefully over the next couple years, your symptoms fizzle out.
13:20
Mara Kamat
Is that what happens post? Okay, I've gone 365 days without a period. Then the expectation is your symptoms will eventually fizzle out. Eventually. How long does that take?
13:30
Dr. Rachel Novik
Can be months. Some people, and like, I wish it on all of us, breeze right through. No hot flashes, no brain fog, nothing. I hope that's all of us. But some people spend seven years with hot flashes. Some people spend 10 years, some people spend six months. Some people have hot flashes when they're 85.
13:47
Mara Kamat
Let's get into that first. Let's hope that's not us.
13:50
Carrie Aguilar
I feel like this is like, you gotta peel back the layers.
13:53
Mara Kamat
So what do you do when somebody comes to you with these perimenopause symptoms? Let's start there. What do you tell them? What do you do? What should we be thinking about?
14:02
Dr. Rachel Novik
So I think about your symptoms, I think about your bleeding, I think about your goals. So I break it. Very generally speaking, I break it up into, do you have regular periods? Do you have irregular periods? Do you have no periods? And that dictates how I might initially approach you. Maybe not long term, but at least to the start. So when you have regular periods, I'm like, if I give you menopause hormones, let's back up for a moment. And so what is hormone therapy? I think is a better question. So there's birth control that we all know. And what does birth control do. It stops you from ovulating and then it gives you the hormones back, so it prevents pregnancy because you don't ovulate. And it gives your hormones, so you don't.
14:49
Dr. Rachel Novik
So you have heart and bone and all of these other good benefits from estrogen. So when you're going up and down and up and down, it makes you nice and flat and then it gives you everything back. Menopause hormone therapy just gives it to you. There's no ovulation suppression. It's just more hormone, much less, compared to a birth control pill, but it's still hormone. And so when I'm thinking about that, I'm also thinking, if I give you this versus this, are you going to start bleeding all the time? Are you going to start bleeding really heavy? What's going to happen? And you can't predict that because everyone is different. Birth control, you have a little more predictability.
15:27
Mara Kamat
But. So I. I recently went on birth control. So I hadn't been in birth control since I was 19 and my OB GYN said, hey, let's try to see if we can get you to be like, more flat, for lack of a better way to say it, less up and down hormonally, just feeling better. So I went on a birth control and I did not feel that right. I felt more ragey, less patient. What do you do when people come to some of those challenges?
15:56
Dr. Rachel Novik
It's hard because I think a lot of people don't want to be on birth control because they're like this. I want something natural. I think that's also an Instagram TikTok problem of don't be on these things because they're not natural. But that's a separate issue. There's hundreds of birth controls, so I think that's the first thing. I'm like, are you open to trying something else? I was on a birth control recently and I was crying all the time. I would think about something and I would just start tearing up. I would read it was like a Folgers commercial. And I would be like.
16:23
Carrie Aguilar
Like.
16:23
Dr. Rachel Novik
That. Yeah. And I was like, that's not normal.
16:26
Carrie Aguilar
And I just cry all the time. I'm like, this is such a good commercial.
16:29
Dr. Rachel Novik
Yeah. And so I switched it and I was like, oh, there we go. I'm not as angry, I'm not as. I have less short temper with my kids. I have. So all of those things, it made a difference for me. And I didn't think, I thought it was like. Not that I thought it was trash, but I Like, I've been on birth control pills for years, right? More than half my life at this point. And I tell patients that all the time. And I will probably stay on them until I'm, like, 55, and then I'll go on menopause hormone therapy. And I'm just gonna breeze through it because that's the plan I have for myself.
16:59
Mara Kamat
That's really beautiful. I really hope that happens. Maybe you could help me solve my problems too. Your brother, my husband, would love you for that.
17:08
Carrie Aguilar
Can I ask two questions? First question is, and I know that this is totally different, I'm thinking, for me, I take Wellbutrin, and what's the difference? Slash, like, how do you know if it's a depression thing or a hormone thing?
17:23
Dr. Rachel Novik
And remember, these are also hormones. Like, serotonin is also a type. They all work in similar parts of the brain. And what is a side effect of a lot of those medications? Hot flashes, night sweats, mood change.
17:36
Carrie Aguilar
So you don't even know.
17:37
Dr. Rachel Novik
You don't always know. And sometimes people come in and I'm like, you're on, like, all of these mood medicines. They could also be doing something. So you can't always have this. That's it. This is gonna fix your problem.
17:48
Carrie Aguilar
So it's like a. It's almost like a process of elimination, and you have to be committed to it.
17:53
Dr. Rachel Novik
You have to be open.
17:55
Carrie Aguilar
Okay.
17:55
Dr. Rachel Novik
Open to it, I would say. And I'm not saying stop your Albutrin or your Lexapro or whatever it is. It's. This might work. This might not. So back to your question of, like, what do you do? Like, do you want to try something in the same family? Do you want to try something completely different? What are your goals? Are you okay with getting pregnant? Because that is a potential possibility if it's not birth control.
18:17
Mara Kamat
If a woman listening today wants to be proactive, what are the most important preventative screenings she should be thinking about through every stage of her life?
18:24
Carrie Aguilar
I love this. I want to know, do I need to get that. That Nuva pro, whatever, full body scan, that.
18:31
Mara Kamat
Bone density scan?
18:32
Carrie Aguilar
I don't know. That Khloe Kardashian does. I need to know, Rachel, if I need to spend $2,100 on a full body scan, can you tell me that right now?
18:40
Dr. Rachel Novik
I don't know what she gets done,.
18:43
Carrie Aguilar
But.
18:44
Dr. Rachel Novik
Probably not. But if you want it, I support you.
18:46
Carrie Aguilar
Okay. Thank you. I appreciate. Appreciate that. Okay, go back to Mara's question. Sorry. I just wanted to know,.
18:51
Mara Kamat
As we move from Every stage of our lives. What should we be thinking about proactively with our health?
18:57
Dr. Rachel Novik
So I think the most important thing are your preventative screenings. So mammograms start at 40, unless you have a family history of breast cancer in an immediate family member, in which case potentially 10 years earlier. So let's say if your mom had breast cancer at 40, you're getting your mammograms at 30. But if your mom had breast cancer at 35, you're still getting your mammograms around 30. Granted, we have breast specialists and other people to see to help you navigate that. But preventative screenings, mammograms, colonoscopy, start at 45. Again, family history is important there. Bone density scans, really not until menopause. The current recommendations are actually not until 65. But you miss the whole window of prevention.
19:40
Mara Kamat
Yeah, like my mom's having issues with her bone density now, and in a way it's kind of too late. Yeah, but it's. What role does hereditary heredity play in all of that?
19:52
Dr. Rachel Novik
Some. It might play in for you, it might not. Right. So genetics, body like for bone density, specifically ethnicity, family history, what medications are you on? Did you ever go a period of time when you didn't have periods for a reason? That's not pregnancy. Right. So we think about a lot of different things. And then pap smears to screen for cervical cancer. And then from general health, I think it's the things you already know, move your body. Exercise, strength training. I think if there's one thing that the younger everyone that comes in to my office hears from me is why start lifting weights?
20:32
Carrie Aguilar
Cool.
20:33
Dr. Rachel Novik
Build your muscle because you're worried about waking. Guess what? The more muscle you have, the more efficiently you're going to burn. It's a natural metabolism booster. So build your muscle when you're eating. Like, we see insulin resistance go up with menopause, so more risk of diabetes. Eat in specific orders, generally speaking. So I try to eat my fiber first. So my vegetables, beans, that kind of thing. Then my proteins, then my carbs. Carbs are lost.
20:59
Carrie Aguilar
Okay.
21:00
Dr. Rachel Novik
Because that's going to help curb your insulin spikes.
21:02
Carrie Aguilar
To.
21:02
Dr. Rachel Novik
Some degree.
21:04
Mara Kamat
Do you find right now you're putting more women on GLP1s? Like with the rise of GLP1s, how do you see that with women's health medicine?
21:12
Dr. Rachel Novik
I find that more people want them. Are they getting them? Are they paying for them? Maybe not necessarily. We have a whole weight management department that we send people to that has Exercise physiology and nutrition along with the medications. Because it's not just one thing. Right. You stop these medications and you don't change your life, you're just gonna gain weight back. Mm.
21:35
Carrie Aguilar
What about supplements?
21:37
Dr. Rachel Novik
I think a lot of supplements are trash.
21:39
Carrie Aguilar
I'm so happy you said that. Okay. But I.
21:41
Mara Kamat
Take like a whole handful we.
21:43
Carrie Aguilar
Gotta need every morning.
21:45
Mara Kamat
Yeah.
21:46
Dr. Rachel Novik
So I only recommend supplements that I test for. Right. So vitamin D is a hill I will die on. We want to see vitamin D levels really between 50 and 80 on a blood test.
21:55
Carrie Aguilar
Okay.
21:56
Dr. Rachel Novik
And we live in Cleveland, so we all are probably low. B12 can help with brain fog fatigue. So I check B12 levels. Iron, specifically, like a ferritin, which is looking at your iron storage level. When people are like, I'm just so tired. I'm like, we need to make sure there's not another reason. And if that level's low, let's go back to preventative screening. Is your colonoscopy up to date? Because are you having silent bleeding that we're not even talking about knowing about? So making sure that we've covered all these bases to make sure we're not missing other reasons all of these problems happen.
22:29
Mara Kamat
Wow. So what about glutathione? Sometimes I take glutathione. How do you see that?
22:35
Dr. Rachel Novik
I think if you like it and it doesn't give you side effect, you can keep taking it. But I think it's a waste of money. I don't think any of them do anything. Yeah.
22:44
Mara Kamat
And I'm taking normal forms now versus just the pills. It's the. The gel from the package.
22:50
Dr. Rachel Novik
And there's some there look, there is some.
22:52
Carrie Aguilar
K dramas and they do a lot of those gels from package.
22:56
Dr. Rachel Novik
Yeah.
22:57
Carrie Aguilar
Having those.
22:57
Dr. Rachel Novik
There is. Look, there's data behind some of them. Right. And I going to get more and more data on more supplements or the peptides and things as time goes on.
23:05
Carrie Aguilar
Oh my God, the peptides. That's a. That's an entirely different.
23:07
Mara Kamat
Thing. Look at peptides.
23:09
Carrie Aguilar
Jesus,.
23:10
Dr. Rachel Novik
Not right now.
23:10
Carrie Aguilar
And there's so many.
23:12
Dr. Rachel Novik
Not. We don't have enough data yet. But as some. Someone the other day was like, why can't you give this to me? But the med spa down the street says, these are great. And I was like, because they're making profit off of this. I have nothing to gain here.
23:24
Carrie Aguilar
So we're not looking at peptides. What about magnesium?
23:27
Dr. Rachel Novik
Magnesium is great. So magnesium glycinate, helps with sleep, helps with muscle cramping. So it's a great supplement. If you need it. L Theanine, which is an amino acid that you can buy over the counter, has a lot of data behind it to help with brain fog, fatigue, sleep.
23:44
Carrie Aguilar
Can you tell me, do you take any supplements?
23:47
Dr. Rachel Novik
I take a prenatal vitamin.
23:49
Carrie Aguilar
Okay.
23:49
Mara Kamat
Why prenatal? You're not pregnant anymore.
23:52
Carrie Aguilar
Your hair. It doesn't.
23:54
Dr. Rachel Novik
Because it sits well in my stomach because I still have them and it has a little bit of everything in them.
24:00
Mara Kamat
Okay.
24:00
Carrie Aguilar
I like that.
24:01
Mara Kamat
Yeah.
24:02
Dr. Rachel Novik
I take vitamin D and sometimes I take an omega supplement if I'm so well motivated.
24:10
Carrie Aguilar
Omega helps with. Fill in the blank. Depression?
24:15
Dr. Rachel Novik
Oh, no, more like cardiovascular.
24:17
Carrie Aguilar
Oh, cool.
24:17
Dr. Rachel Novik
Yeah. But there is data showing that people who have low omegas and our menopausal perimenopausal have worse symptoms.
24:26
Carrie Aguilar
Oh. So we should maybe take again.
24:28
Dr. Rachel Novik
How many supplements do you want? How many, literally, fish oil.
24:32
Carrie Aguilar
Burps.
24:32
Dr. Rachel Novik
Do you need?
24:33
Carrie Aguilar
I'm taking, like, a full fistful.
24:34
Dr. Rachel Novik
Yeah. And then. And then if you're like me, I stop taking them all.
24:38
Carrie Aguilar
And then when I take it just sits in my stomach and then I pee and it's, like, bright green.
24:43
Dr. Rachel Novik
Yeah.
24:43
Mara Kamat
Yeah. I take quite a few. Got some viracon, got vitamin C, got vitamin D, got some magnesium. Sometimes I'll take. And my probiotic.
24:55
Dr. Rachel Novik
There's not great probiotic data.
24:58
Mara Kamat
Should we not be taking probiotics?
25:00
Carrie Aguilar
Maybe, like, a year?
25:01
Dr. Rachel Novik
Yeah. Like, I get it from my yogurt. I don't think that it's. I don't think it's bad. It's just, like, how much money do you want to spend on these things? And that's really, like, how much money and how much time?
25:10
Carrie Aguilar
Yeah.
25:11
Dr. Rachel Novik
And what do your bowels think of you after you take all of those things?
25:15
Carrie Aguilar
So what advice would you give someone who feels like something isn't quite right but they don't know where to start?
25:21
Dr. Rachel Novik
Honestly, I'd say start with your primary care, but sometimes that's easier said than done because they're so overwhelmed with managing all these other problems, and they just don't have the time to do that. If you're going in with this focused conversation, I think that's a different story. But a lot of people are really looking into, like, functional medicine right now because they're ordering these big panels and explaining them and saying, this is what, something that can help with this, and this is something that can help with that. Someone like me, I'm ordering little snips of that, but not all of it. And it's like a dance of primary care functional Medicine, endocrinology, like these are all, we're all kind of intertwining and we're seeing that like even people who are on like the GLPs, like some.
26:09
Dr. Rachel Novik
I have people that are like, I don't need to see you anymore. I feel great. My hot flash has stopped. My GLP is all I need. So there's like an inflammatory something component to this too.
26:21
Mara Kamat
One of the things I've been thinking about doing is like going to a longevity clinic that kind of like pulls what I would call like a lot of this together into one place in a given period of time. Maybe it's a week or eight or nine days, however long it is, depending on the clinic that you choose to really tell you. Like what can you do to change the way that you eat and live to live longer? How do you look at.
26:46
Dr. Rachel Novik
I think that the crux of it is probably that they're not going to tell you something you don't already know. But it goes back to, I think if we eat more vegetables in a mainly plant based diet, if we're moving our bodies and having dedicated focused exercise and muscle building and we're sleeping, we're getting good sleep, those are the things that are really going to help and decreasing our stress. Easier said than done. But like those are the things that are really gonna help us long term. It's not gonna be taking this supplement or this infusion or this medication.
27:21
Carrie Aguilar
If I come to you during an appointment, what information should I bring with myself to be able to best empower you or give you like the best direction?
27:30
Dr. Rachel Novik
Really it's just you.
27:31
Carrie Aguilar
Okay.
27:32
Dr. Rachel Novik
Because if there's something that I wanna look at, I'm gonna order it, right? Okay. So I don't need anything. I really just wanna know what you have to say and what your goals are. I think it's hard just in medicine nowadays because you're on this X amount of time slot and you're trying to do all of these things. And I think that balance is definitely hard, especially for these conversations and for OBGYN when they have 10 minute visits because it's like we visit. Oh, this person has annual and wants to talk about their hormones and then they just don't have time. So there's not always that like time for explanation. This is why I picked this for you. So being able to just find someone that can sit and listen and explain things makes a big difference too.
28:12
Mara Kamat
How do you feel that medicine is supporting women in this journey today versus how they did maybe five years ago.
28:20
Dr. Rachel Novik
It's getting much better. We have at the clinic, we've had a whole center for specialized Women's Health for 20 plus years. But now there's the Women's Comprehensive Health and Research Center. I'm not sure, I might have butchered that, but we have this dedicated research department and women's health department for all of these things and physicians and nurse practitioners and PAs who are dedicating their specialty into how is women's health changing all of these other things. So I think we're getting more and more. It's still not enough.
28:57
Carrie Aguilar
Because there's not a lot of historical data. Right. We're just starting to build it now.
29:01
Dr. Rachel Novik
Yeah.
29:02
Mara Kamat
But think about this. I often think about this and it's like chip on my shoulder to say it, but it's true. Think about when the investment that was made in the evolution and discovery of Viagra.
29:14
Dr. Rachel Novik
Yeah.
29:14
Carrie Aguilar
Oh yeah. I want to.
29:16
Mara Kamat
If we took that billion dollars, I think, and reallocated it to some subset of women's health, what would women's health look like?
29:24
Carrie Aguilar
And I think it was very recently that the first like sexual women's health pill got like FDA approved.
29:31
Dr. Rachel Novik
Addie's been around for a while.
29:32
Carrie Aguilar
Okay,.
29:33
Dr. Rachel Novik
Maybe not, I don't know how long, but it was just re approved for post menopau women. It was only approved for premenopausal women. And Addie is $250 for a three month supply.
29:45
Carrie Aguilar
And Viagra is $10 two.
29:47
Dr. Rachel Novik
Bucks. Yeah, I don't actually know, but dirt cheap.
29:51
Carrie Aguilar
Yeah.
29:51
Mara Kamat
Yeah. So there's also this whole idea around accessibility of the support that women need.
29:56
Dr. Rachel Novik
Yeah,.
29:57
Carrie Aguilar
That's a lot to think about. I feel like. Yeah, I don't know. How can you talk a little bit about hormones and if someone is in paramount, like what sorts of hormones, like do you prescribe them? It used to be that people said please don't give people like,.
30:17
Dr. Rachel Novik
So let's go backwards to 2002. There was this big study that was published that said menopause hormone therapy gives you heart attacks, strokes, breast cancer, all of these bad things. And everyone stopped taking hormones.
30:28
Mara Kamat
Yeah.
30:29
Dr. Rachel Novik
And since then, like in 20, 25, so 20 plus years later, they finally reassessed that data and said, oh, it's actually broken up into these subcategories based on age. And this wasn't quite the right age group to look at and all of these things. And that's why we found this data and the breast cancer piece, like specifically for breast cancer. It was for every 10,000 women there were eight additional cases of breast cancer, no additional deaths, and it was with a specific type of progesterone, the estrogen only arm of that study. So for women who didn't have a uterus, there was protection. So estrogen is thought to be protective against breast cancer. Progesterone is thought to be the thing that has increased risk.
31:16
Carrie Aguilar
Wow.
31:17
Dr. Rachel Novik
But if you have a uterus, you need estrogen and progesterone, because if you have estrogen without progesterone, you are at higher risk of endometrial or uterine cancer.
31:28
Carrie Aguilar
Okay,.
31:28
Dr. Rachel Novik
So it's a balance, right? And back to birth control. So birth control, we know, prevents ovarian and uterine cancer because of the ovulation suppression and the balance of those two hormones. Menopause hormone therapy doesn't have that same ovulation suppression. We know you need that progesterone because what does estrogen do but make that lining of the uterus thick? And it's these rises and falls of estrogen and progesterone that trigger your periods each. So estrogen makes it thick, progesterone helps keep it thin. And so you need both if you have a uterus, whether that's through a Mirena iud, through oral micronized progesterone, which is the common one called prometrium norethindrone, which is like birth control, the mini pill, that kind of thing, or other types that are not as often used. And then estrogen is what tends to get rid of your symptoms.
32:20
Dr. Rachel Novik
Not always 100%, but it's a balance of those two.
32:23
Carrie Aguilar
So hormones are no longer. No, no. We actually went back to the 2002 data and realized that were wrong and how were like deciphering it.
32:32
Dr. Rachel Novik
Exactly. So specifically for heart risk, from a cardiovascular standpoint, women who are started on hormones between 50 and 60, so 50 and 59, it leans more towards there's benefits, prevents plaque buildup, lowers your risk of long term heart disease. So there's all these good things. It helps prevent the sharp decline in bone loss with perimenopause, and so it can help prevent osteoporosis. There's all these good things that it does. But were scared away because that study looked at the wrong chunk of data.
33:01
Mara Kamat
Why aren't you looking at those same hormones for women age 40 to 50?
33:06
Dr. Rachel Novik
I think we will. I think it's just been a matter of funding, honestly, and the fact that people weren't talking about it before then, or if they were, it was in a very small setting and it was the people we know that women who have their ovaries out. So if they had a preventative hysterectomy with their ovaries taken out or something like that, they need estrogen. The recommendations are like, immediately put them on hormones because you need that heart, you need that bone protection. But we don't have any of that for the 42 year old who doesn't feel quite like herself. But birth control isn't the right answer. We don't have that data.
33:42
Carrie Aguilar
You know what's interesting? Both my grandmother and my mother had preventative hysterectomies. And my mom, literally every time I go to my gynecologist, she begs me to somehow make it possible for me to have a hysterectomy because I'm done having children. She's just ask. And now they don't do it. They used to do it more often, now they don't. There has to be a huge reason why. But my mom, this is a hill that she will. She's. I will pay for this surgery so that you don't have to walk down this road. Because she loves the fact that she got a hysterectomy at the age of 35. She never had to go through menopause, and she got these hormones.
34:22
Dr. Rachel Novik
Did she have her ovaries taken out?
34:24
Carrie Aguilar
Mm, she got everything taken out. Isn't that what a hysterectomy is?
34:28
Dr. Rachel Novik
So you can have just your uterus taken out and you can have your uterus and your ovaries taken out and the tubes that kind of.
34:34
Carrie Aguilar
Connect.
34:34
Dr. Rachel Novik
Them could just have your ovaries taken out. So there's options.
34:38
Carrie Aguilar
I'm not sure I know, but this is all to say, she's so bullish. And my gynecologist, who's amazing, I think she's great, but she is like, no, we don't do that anymore.
34:49
Dr. Rachel Novik
And we don't. But if you have a reason for it, that's a different conversation. But my.
34:53
Carrie Aguilar
Mom's like coaching me on those reasons. Negative. She's just talk about heavy bleeding. So heavy.
34:59
Dr. Rachel Novik
It's a major surgery though, so there's also a lot of other risks. You mentioned potential long term effects. You might find that you have more ladder prolapse, so things can just fall a little bit more. Meaning you're. Could you end up with another surgery?
35:13
Carrie Aguilar
Yeah. Okay, that's fair enough.
35:14
Dr. Rachel Novik
So then that's like the easy one to just use as an example.
35:18
Carrie Aguilar
Cool, I'll listen to the doc. Nothing against my mom, but she did not go to medical school.
35:23
Mara Kamat
Another thing on this topic, though, that you just brought up, that I think women struggle, at least, like, I personally struggle with it. I had my two kids vaginal childbirths, and now it's like, I almost pee my pants all the time. What advice do you have for women who are struggling to hopefully not pee their pants post childbirth?
35:42
Dr. Rachel Novik
Is it coughing, sneezing, peeing? Or is it when I gotta go? Cause those are two different. Potentially two different approaches, right?
35:50
Mara Kamat
Why don't you tell us,.
35:50
Dr. Rachel Novik
Wolf? So coughing, sneezing tends to be muscle. So that's pelvic floor physical therapy. Strengthen those muscles. And it's not go do your Kegels, it's make sure you're actually doing your Kegels. Because sometimes women are like, I'm doing them. And I'm like, no, you're squeezing your butt or like your legs are moving. And that's not. Those aren't the right muscles.
36:08
Mara Kamat
It's actually really interesting because I'm going to pelvic floor physical therapy right now. And for me, it's all about elongating, like, how I sit up straight and building my core muscles stronger. And it was, like, completely different than the issues I thought I was having. Yeah, it's been incredibly educational, but also I am working with a trainer and myself on exercises to build those muscles differently so I can manage it better.
36:35
Dr. Rachel Novik
Yeah, that's exactly. It's not just, oh, do your five kegels or your 10 kegels at the stoplight.
36:41
Carrie Aguilar
And then asking for a friend. What about the other one? When you just.
36:45
Dr. Rachel Novik
So that one can be a lot of different things. That one can be hormones, that one can be muscle, that one can be a little bit of everything, which makes it easier in some ways and more difficult in some ways. Like, vaginal estrogen cream is like all of our best friends. Everyone should probably be on it by the time they're perimenopausal. It can help with blood flow back to your tissue.
37:06
Carrie Aguilar
Like literally just putting cream.
37:09
Dr. Rachel Novik
Yes, essentially. Yeah. It's not glamorous, but.
37:12
Mara Kamat
What does it do?
37:14
Dr. Rachel Novik
So estrogen helps with blood flow back to your tissue. Right. So if you have better blood flow, you can have better control less over firing of those nerve signals, all of those things. So it can help you at least get to the bathroom. Or maybe instead of waking up five times at night, you're like, waking up twice. That would be like, my ideal goal is like, maybe it's not gone, but you can at least get where you need to go.
37:37
Mara Kamat
Is this an over the counter thing or something that the doctor prescribes? Got it. So we gotta go to our OB GYN to prescribe that.
37:45
Dr. Rachel Novik
Yeah. But it's very low systemic absorption. You don't need to have progesterone or an IUD or something just to use it. It's just really there to help your tissue.
37:55
Carrie Aguilar
And then what is just. I know you've talked a little bit about birth control in your mind because I have a young child, she's 10, she will be getting her period within the next few years. Can you kind of break down for me that sort of. Because it sounds like you're on birth. I'm not on. I should say I'm not on birth control. I was like the person who was on birth control for two months when I was 21 and my husband, my boyfriend at the time, beg me to get off so. Because I was crazy. And I just have never gone back on. So from your perspective, can you talk a little bit about going through puberty and then having that if that is something that you are encouraging of or regardless of, like the birth control? Yeah,.
38:38
Dr. Rachel Novik
It's not. It's in all of these places. It's hormone replacement therapy. It's replacing what your body would naturally be doing. So that's another way to think about it. But. But it can make periods lighter. It can help with cramps. In a lot of cases you can skip your period altogether if you so choose because it's inhibiting ovulation. The withdrawal bleed. The week of sugar pills is a male designed phenomenon. Yeah, it's a fake period. So it's just because you don't have the hormone anymore that you bleed. And I think, I don't know the actual lore behind it, but her, whoever this was like a thing that made women feel normal, but designed by a man.
39:26
Mara Kamat
Interesting.
39:26
Carrie Aguilar
Whoa.
39:27
Dr. Rachel Novik
How true any of that is. Don't.
39:29
Carrie Aguilar
Mind blown. So you're not like against. You're not against teenage girls getting on okay.
39:34
Dr. Rachel Novik
No. Especially if they're like. If they're having heavy periods or they're really bad cramps. Like it can make a lot of a difference. It might not be that things are beautiful and great. I still had cramps throughout my teens and twenties and all of that. But at least everything was controlled and short and I knew what to expect after X amount of time.
39:55
Mara Kamat
Have you had that conversation with your teenager who maybe comes to you and says, oh my God, mom, my period is so bad I don't know what to do.
40:04
Dr. Rachel Novik
I Think that's when. And I have a lot of moms bring their kids in because I see their moms for their hormones. And then they're like, I want you to see my daughter. And I think that she needs something. And when you're 12, even when you're 17, an IUD is a bit invasive. I don't know that I want that now, let alone when I'm 17 or 16 or whenever. Not because there's anything wrong with them, but it's an invasive procedure. I think that it's really a matter of, like, how much are you suffering? Is this something that could really make a difference for you? Are your mood changes so significant? Like, is this something that can really impact your functioning? I used to miss school because my periods were so bad all the time.
40:47
Mara Kamat
The mood change thing is so hard as a parent because you're like, is this hormonal? Is this teenager? Is.
40:52
Dr. Rachel Novik
This you? Is this me? Whose hormones are.
40:55
Mara Kamat
Yeah, yeah. It's really hard to kind of navigate. Especially now getting into this 13, 14 year old stage. It's getting much more challenging to figure that out.
41:06
Dr. Rachel Novik
I have a couple women who have. Are like, right at the end, they're like, I went 11 months with no period. Then my daughter got her period, so now I got my period again. And they were like, this is not what I wanted in my life. And I was like, I.
41:20
Carrie Aguilar
Sorry.
41:20
Dr. Rachel Novik
I'm sorry.
41:22
Mara Kamat
So they no longer meet the definition of menopause. And they talk about that.
41:24
Dr. Rachel Novik
Technically, yeah. And they're like, regular because of that. Just weird cycle sinking phenomenon.
41:30
Mara Kamat
Interesting.
41:31
Carrie Aguilar
Rachel, what's one message that you hope every woman walks away with today?
41:36
Dr. Rachel Novik
Strength training.
41:38
Carrie Aguilar
I love that.
41:40
Dr. Rachel Novik
I think it helps with your mood, it helps with your bones, it helps with your preventing, hopefully preventing falls because you're working your core also. It's one of the best things we can do for ourselves and we should all be taking the time to do it.
41:53
Carrie Aguilar
So we always like to end our sessions with two questions. The first is, what is bringing you joy right now?
42:00
Dr. Rachel Novik
I think one thing, two things that bring me joy are my kids. They are three and a half, almost four, and one and a half, almost two.
42:08
Carrie Aguilar
Wow.
42:09
Dr. Rachel Novik
And they like to play and smile and hug and send videos. They're just, you know,.
42:17
Carrie Aguilar
They're just in those really cute spaces, the.
42:19
Dr. Rachel Novik
Cuddle, snuggle phases. And I'm trying to enjoy it.
42:23
Mara Kamat
How do you balance that? Like, you have this big career as a doctor and, you know, trying to be a mommy. How do you balance those things?
42:31
Dr. Rachel Novik
It's really hard. And you and I talk about it a lot. I struggle with it. There's a lot of work in being a doctor and being a successful, even an unsuccessful. I don't know what unsuccessful means, but in being a working,.
42:44
Carrie Aguilar
A mediocre doctor. And I'm not trying to.
42:47
Dr. Rachel Novik
Be human. And there's a lot of work to just be a working human. Right. Let alone to be a non working, taking care of kids, like human. And it's like, how do you balance that? I don't. I. Fortunately, I have some great role models, but it's still hard.
43:07
Mara Kamat
Yeah, it is hard. Rachel and I do talk about it. I feel like were just talking about it last week and I feel like I was so busy working when my kids were this age and I was like traveling the world two to three weeks every single month in a different country. And I feel like I missed out on this phase. And I've chosen to work how I work now, so I don't miss out on all the things. But I said that to her. Hey, no matter what you do, as you're managing your time, it just. It goes by so fast.
43:40
Dr. Rachel Novik
Yeah. And it's to the point already that I'm like, do I need to change my hours? Do I need to change how I do this? Because I don't want to miss things I already get home in time for. I miss dinner, I get bath and I get bed. And in the middle of that, I'm like trying to eat and chill for a moment and strength train. Like I said, I gotta. We all should. We all be so lucky. But yeah, it's hard.
44:09
Mara Kamat
Yeah. The other question we like to ask Rachel is if you could go back in time, what piece of advice would you give your younger self?
44:17
Dr. Rachel Novik
I think just reassurance that things will work out. It's okay if it's not the right. The perfect route. It's okay if you make mistakes. It's okay to just keep trying. And we're all doing our best.
44:31
Mara Kamat
Yeah, absolutely. I think the other thing we didn't really cover, but I think it's important for our listeners, is like, we're all dynamic humans navigating different stages of life. And I think one of the challenges you've had too, is you were so young when your dad got sick in 2020, and you've had to navigate having your kids, being in med school, finishing residency, fellowship, and helping to care for a sick parent. How have you navigated all that?
45:05
Dr. Rachel Novik
Probably not that well. But I think that's also something I grew up with a lot of people like coddling me, for lack of a better way to say it. And it's been really a balance of figuring out who am I in the scheme of family, in the scheme of career, in the scheme of who do I want to be.
45:29
Mara Kamat
Rachel, thank you so much for joining us today. This conversation felt especially meaningful and special because you're my sister in law and you're an incredible women's health doctor and I'm so proud of you. And I'm also like so lucky and blessed to bring this information forward for other women and for us to give back in such a beautiful way. So I'm so appreciative of you being here. Thanks for having.
45:51
Carrie Aguilar
Me. And I will spend time actually writing down exactly all the supplements that you recommend.
45:58
Mara Kamat
Please note this episode does not contain medical advice and is intended for entertainment purposes only. Please consult your medical clinician before starting any supplements or medication. Thank you for tuning in to In Her Land. If you love this conversation, please share it with a friend. Leave us a review and keep following along at inherland.com where we highlight more incredible women making an impact. Until next time.
