Decoding Happiness in Midlife with Dr. Laurie Santos

Sex is supposed to be fun and feel good. So why are pain, low desire and changes in arousal so often treated as something women should simply live with? Dr. Poynor is joined by urologist and sexual medicine specialist Dr. Rachel Rubin for a candid, joyful conversation about women’s sexual health. They unpack what’s behind common sexual concerns, available treatments, and why these issues deserve the same curiosity and care as any other part of our health. Along the way, Dr. Rubin makes the case for talking about sex more openly – and for expecting more from the care we receive. Links to resources mentioned in this episode: For more information on the treatment options for vulvar pain: https://journals.lww.com/greenjournal/fulltext/10.1097/aog.0000000000001645~committee-opinion-no-673-persistent-vulvar-pain The American Urological Association’s clinical guideline on genitourinary syndrome of menopause: https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause Dr. Rubin offers continuing medical education courses for clinicians, as well as free educational sexual health resources: https://www.rachelrubinmd.com/education Learn more about Dr. Rubin’s Sexual Medicine Research Team: https://www.rachelrubinmd.com/research Read the FDA’s update on estradiol transdermal patch availability: https://www.fda.gov/drugs/drug-alerts-and-statements/fda-update-estradiol-transdermal-patch-availability Research on erectile dysfunction and its relationship to cardiovascular health: https://pmc.ncbi.nlm.nih.gov/articles/PMC10353735/ Research on hormonal contraception and sexual function: https://www.sciencedirect.com/science/article/abs/pii/S1743609515312881 More information on the FDA approval of flibanserin for hypoactive sexual desire in postmenopausal women: https://www.urologytimes.com/view/fda-approves-flibanserin-for-hypoactive-sexual-desire-disorder-in-postmenopausal-women Information about testosterone treatment available for women in New Zealand: https://www.androfeme.nz/ Research on vibrator use among women: https://pubmed.ncbi.nlm.nih.gov/19453881/ Prosayla, a resource from the International Society for the Study of Women’s Sexual Health (ISSWSH), can help you find clinicians who specialize in women’s sexual health: prosayla.com Dr. Rachel Rubin website: https://www.rachelrubinmd.com/ Dr. Rachel Rubin on YouTube: https://www.youtube.com/@DrRachelRubin Dr. Rachel Rubin LinkedIn page: https://www.linkedin.com/in/rachel-rubin-7433b0134/ Dr. Rachel Rubin on Instagram: https://www.instagram.com/drrachelrubin Dr. Rachel Rubin newsletter: https://www.rachelrubinmd.com/newsletter Dr. Elizabeth Poynor substack: https://poynorhealth.substack.com/ Dr. Elizabeth Poynor on Instagram: https://www.instagram.com/poynorhealth Atria Health Library: content.atria.org Note: In this show, we use “women” as shorthand for people with XX chromosomes. We understand sex and gender are more complex, and acknowledge the experiences we describe reach beyond that word. See omnystudio.com/listener for privacy information.

Heart disease is the number one killer of women, but unlike many other major diseases, there’s no single screening test that can tell you if you’re at risk. So how do you know where you stand? Dr. Poynor is joined by cardiologist Dr. Anuradha (Anu) Lala-Trindade (Lala), the program director for the Advanced Heart Failure and Transplant Fellowship at Mount Sinai and a professor of cardiology, population health, and obstetrics and gynecology. Together, they unpack the many factors that can shape a woman’s cardiovascular risk and break down why midlife is an especially important time to start paying attention to them. Resources mentioned during this episode: Dr. Anu Lala’s 14-part framework for an initial cardiology assessment: 1. Family history 2. Gynecologic history — pregnancy journey, fertility journey, and gynecologic surgeries, including fibroid surgeries 3. Laboratory results — genetic risk markers plus microalbuminuria (protein in the urine, as an early marker of cardiovascular-relevant kidney health) 4. History of high blood pressure — personal history, in-office reading, and family history 5. Cholesterol panel 6. Insulin resistance and inflammation biomarkers 7. History of autoimmune disease or inflammatory conditions 8. An EKG to check for any abnormalities 9. Weight and weight redistribution 10. Sleep 11. Movement (her preferred term over "exercise") 12. Diet — specifically processed food intake, alcohol, and food timing 13. Tobacco use and cessation 14. Mindfulness and well-being, or mind-body medicine Here are the numbers Dr. Lala wants women to know. 1. Blood pressure 2. Cholesterol panel 3. Lp(a) — a genetic marker of atherosclerosis, checked at least once 4. Hemoglobin A1c — a marker of insulin resistance, metabolic risk, or diabetes 5. Microalbuminuria For some women, she also recommends: 1. ApoB — not for everyone; informative specifically when LDL is elevated 2. Coronary artery calcium score — not for everyone; useful for those at intermediate-to-high risk, with high LDL, or with a relevant family history About Dr. Lala: https://profiles.mountsinai.org/anuradha-lala-trindade#about CDC overview of women and heart disease: https://www.cdc.gov/heart-disease/about/women-and-heart-disease.html National Heart, Lung, and Blood Institute resources for women and heart disease: https://www.nhlbi.nih.gov/health/coronary-heart-disease/women#How-do-symptoms-differ-for-women? A Harvard Health article on the heart attack gender gap: https://www.health.harvard.edu/blog/understanding-heart-attack-gender-gap-201604159495 Systolic Blood Pressure Intervention Trial (SPRINT) Study: https://www.nhlbi.nih.gov/science/systolic-blood-pressure-intervention-trial-sprint-study Hypertensive disorders of pregnancy and peripartum cardiomyopathy: A nationwide cohort study: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0211857 Increased risk of cardiovascular disease in women with endometriosis: A systematic review and meta-analysis: https://www.sciencedirect.com/science/article/pii/S0301211525003574 The 2022 hormone therapy position statement of The North American Menopause Society: https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf If you're interested in using a risk calculator you can toggle to the left on the American Heart Association tool: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator Auditory stimuli and heart rate variability: the role of music in cardiovascular regulation: https://pmc.ncbi.nlm.nih.gov/articles/PMC13229774/ Adjuvant music therapy for patients with hypertension: a meta-analysis and systematic review: https://link.springer.com/article/10.1186/s12906-023-03929-6 Effects of music in exercise and sport: A meta-analytic review: https://pubmed.ncbi.nlm.nih.gov/31804098/ Association between spirituality/religiousness and quality of life among healthy adults: a systematic r

How can the research behind intermittent fasting help us rethink the way we approach our nutrition and our daily habits? Dr. Chris Rhodes has spent much of his career studying the science of fasting. He joins the show to unpack how fasting works in the body and what the research tells us about its potential benefits. Dr. Rhodes earned his PhD in Nutritional Biochemistry at UC Davis and is also the co-founder of Mimio. We discuss why someone might try intermittent fasting - from longevity to weight loss - as well as the importance of strength training and personalized nutrition. Links to resources mentioned in this episode: For more studies on autophagy, check out: https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/JP287938 and https://pubmed.ncbi.nlm.nih.gov/41372565/ Here's a meta-analysis looking at the effects of time restricted eating: https://pubmed.ncbi.nlm.nih.gov/41586347/ Note: the glycine data we mention is only in mice: https://pmc.ncbi.nlm.nih.gov/articles/PMC6516426/ Important caveat for this episode: the evidence is strongest in animal studies and human markers of aging. No intermittent fasting regimen has been shown to extend human lifespan or reduce mortality in humans. Note: In this show, we use “women” as shorthand for people with XX chromosomes. We understand sex and gender are more complex, and acknowledge the experiences we describe reach beyond that word. See omnystudio.com/listener for privacy information.

What can you do to make the most of your annual medical visit? Dr. Poynor is joined by Dr. Jennifer McGugins Hill, an internal medicine specialist at the Atria Health and Research Institute, to discuss how preventive care can help identify health concerns early. Plus, we unpack which labs and screenings are worth discussing with your primary care physician, why it's important to know your calcium score, and how to advocate for the care you need. Links to resources mentioned in this episode: Boston Heart Diagnostics offers specialty labs that your doctor can order for you, usually at a cost. They are not available as direct to consumer products, so if you're interested in them, talk with your care team. https://bostonheartdiagnostics.com/ For expert advice on how to properly log your blood pressure at home, please see this helpful article: https://content.atria.org/article/blood-pressure-cuffs-for-home-monitoring/ You can see the product she mentions here (no affiliate link): https://omronhealthcare.com/blood-pressure-monitors An ECG or EKG stands for an electrocardiogram, which is a quick, safe, and painless medical test that records the electrical activity of your heart. DEXA stands for dual-energy X-ray absorptiometry. It is an imaging test that uses low-dose X-rays to measure bone mineral density and body composition. They can be ordered by a physician in an academic medicine system and are also offered at standalone centers. Cologuard is a stool test that looks for existing cancer. Colonoscopies look for cancer as well as polyps, which can be pre-cancerous and are removed during the colonoscopy procedure. Note: In this show, we use “women” as shorthand for people with XX chromosomes. We understand sex and gender are more complex, and acknowledge the experiences we describe reach beyond that word. See omnystudio.com/listener for privacy information.

Many women are turning to cannabis to help with sleep, anxiety, chronic pain, and other major health concerns. But figuring out what actually works for your individual needs can be surprisingly complicated. Dr. Poynor speaks with neuroscientist and world-renowned medical cannabis expert Dr. Staci Ann Gruber about the science behind THC, CBD, and other cannabinoids. Together, they break down the potential benefits of cannabis for women’s health, how to navigate different products safely, and best practices for first-time users. Links to resources mentioned in this episode: Marijuana Investigations for Neuroscientific Discovery (MIND) Program at McLean Hospital Women’s Health Initiative at Mind (WHIM) Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research Marijuana impacts mood in bipolar disorder: a pilot study Note: In this show, we use “women” as shorthand for people with XX chromosomes. We understand sex and gender are more complex, and acknowledge the experiences we describe reach beyond that word. See omnystudio.com/listener for privacy information.