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.

What You'll Learn

• 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.

Get in Touch with Dr. Banire

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Hey y'all, it's me, Dr. Smee Urman Gyno Girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. I'm Dr. Smeen Uman, board certified OBGY and sexual medicine and menopause specialist. Today I'm super excited to have a dear friend of mine on the podcast to talk about so many women's health issues, particularly from an international lens. We want to delve into different cultures experiencing different women's health concerns as well. I'm so excited to have my dear friend Yoan.

huh.

They Bena Benayer, Benayer?

Banner,

Bonare. Okay. I'm so excited to have my dear friend Yolanda Bonner here today. and we are gonna get into it. Thanks, Yuanda, for the being here, sis. Appreciate you.

Absolutely. Absolutely. Thanks for having me. You're doing a great work. So thank you.

Thank you so much. I'm gonna give you a little introduction to Dr. Yuanda Banara is a family nurse practitioner, educator, and advocate whose clinical and advocacy work focuses on women's health, particularly across the reproductive and midlife spectrum. She is the founder of the Serene Infusion and Wellness Lounge in Illinois and Serenara. Well Sara Serenara? Saranara. Saranara.

So no. Mm-hmm.

Carrie, you have to edit this. Sarah Nara Wellness in Lagos, Nigeria, where she provides clinical care while working to close gaps in women's health and education access. Born and raised in Lagos, Dr. Banara brings a cross-cultural perspective to the challenges women face across different health systems. Her work extends beyond the clinic through public education, media, community campaigns, and advocacy in reproductive health, perimenopause, sexual health, maternal health, and women's autonomy. At the heart of her work.

A commitment to making evidence-based women's health more accessible, culturally relevant, and more responsive to the realities of women's lives. Thank you so much. I'm so excited. So, you know, we always like I'm you know, as as a gyno girl, I like a good backstory. So I always want to know like what brings somebody into this field, especially because so many of the people that I'm talking to are in sexual medicine, menopause, perimenopause, and you know, although it's gotten traction.

Yeah.

And now I think, you know, when some of us entered, it wasn't, you know, as popular, I guess. So tell me what Yoana, what brought you into this area, like what experiences that you had that makes you feel like, you know, this is what I want to do.

You know what, it actually started with my own experience. as a black woman, navigating the healthcare system is not usually very straightforward. You have to advocate for yourself three times as hard. And I was diagnosed initially with fibroids when I was eighteen in Nigeria. And the reason for that early diagnosis was because my mom at eighteen, mm-hmm. And the reason for that diagnosis was because my mom was an accountant and she worked with the hospital board system.

Yes.

Eighteen. Uh-huh. Wow, okay.

So the way it works in Nigeria is that it's not so easy to see a doctor and you don't I mean things are changing now, but growing up, you don't necessarily have like a primary care doctor that you go to. You only go to the hospital when you're sick. Okay. So that's just how the structure is over there. So but at eighteen, my period was super intense. I would I started my period bleeding for seven to ten days. Like

Yeah.

I can't relate to people that say they have they only messaged for like three to five days. I'm like, What? I didn't even know that was a reality until I became much older. So

Yeah. That happened. That's real.

And then the only thing they told my mom was like, well, she would you know, it would go away, you know, just make sure she has kids super early and she'll be fine. And it they just said it was part of being a woman because in our culture, we believe that growing up was, you know, as a woman it comes with pain. And it was expected for you to have painful menstrual craps, it was expected for you to bleed for days, not be functional during your menstrual cycle. It they just said it was part of being a woman. So but nobody did anything and then I, you know, relocated to the United States.

with it you know, with the history of fibroutine, no one still really did anything about it. They just, you know, watched it and just said, you know, it is what it is. And then I went into perimenopause. So I didn't even know it was perimenopause. I just know that I've been able to manage it well from 18. All I know is pain. So my vampiroid is coming, it's so much pain and apoprofane and maybe a leaf or Tylenol has always been able to help until I turn 38.

Yeah.

Yeah.

Yeah.

At 38, I started having this crazy flex, right? It was so intense. I couldn't, ipoprofen couldn't help it, Advil couldn't help it. I was it was different, right? Then now my my period cycle changed so much so that I would start to have PMS two weeks before my period. And it's not just the mood swings, it was intense back pain, it was cramping.

So something had changed. So I went back to my doctor and I said, Hey, you know, something is different. You know, nothing has changed in my life. I'm not under any amount of stress. I haven't changed my diet. I haven't changed my lifestyle. But this period and this pain has changed. And she was like, Well, you know, it's the fibroids, and at some point, you know, whatever we did before, it just, you know, wasn't working anymore. And I said, Well, what

So what are we gonna do? And she was like, okay, you know, we can do an instruct me. And I said, No, I don't want to instruct him. I was only 37. I was like, I don't think that would should be the first thing we should go for. I mean, I don't want that. I said, there has to be other ways. And she was like, okay, well, you know, let's monitor it. We did a transvaginal ultrasound. And it was about, you know, about the side of size of an 18 week pregnancy at that point. So it is big.

No. Yeah.

And I have intramural and I have submucosals. I have in both. And she was like, Well, you know, that's just what it is. It's just changing. And I just realized that now I couldn't sleep anymore because the pain will wake me up from sleep. I would cramp all the time. And I was miserable. And then I thought thirty eight. And then at some point we got it together, you know, I was able to get under control. We didn't really change anything. It was just that profene the flare went away.

And then I turned 38 and it was getting more intense. And I was like, there's just no way. And I was going from one doctor to another. I went to my obiguine. And she was like, Well, it's the fibroids. Because I feel like once you have some medical prior medical history, I feel like everybody just eyes under that umbrella. You know what I mean? Nobody wants to do any additional work. No, nobody wants to do that. It was just like, it's the fibroids, you know. And then my primary care doctor said, you know, go back to your obiguine. my God. And I was like, this is insane. And

Yeah, yeah.

Yes. Yeah. No one's no one's doing the investigative work. Yep. Yep.

started looking into parametapals because I was like there has to be something that is changing that is causing this back to back flare without me really changing anything. And then I stumbled across parameters. And it's so interesting that I had to stumble across parameters because I was experiencing like it wasn't like

But isn't it so funny to be in this field and still not recognize it in yourself? Like that's how I felt too. I was like, wait.

And that was the craziest part of it. Like I was like to be in this pu I Right? And I was like, this is no, this is not okay. And and I said, so I went back to my doctor.

'Cause we gaslight ourselves too, right? Like I think we gaslight ourselves.

Absolutely, because you're just like it can be that. And then you have you also have some of these myths that says, you know, if you have fibroids, you can be on HRT. And you have different things that then you have to navigate based on your own history, right? So now I'm like, okay, you know what? I already know with fibroids we have estrogen dominance, right?

And I know that the first hormone that declines during primary menopause is progesterone. So that means that I don't have the primary hormone that was helping me balance the estrogen at some point. And that has to be what's going on. Of course, I was like, okay, now I'm navigating, I'm investigating myself, right? And then I'm gaslighting myself as I as I investigate, because I'm like, no, you know, my old big guy, I've seen like three, four different doctors. I mean, somebody will recognize it. You know what I mean? Like, I'm like, I'm not any special. There has to be.

Yeah.

Yeah.

Sure.

I know.

It's but you know, our system is broken. I always say this, our system is broken. It's like how much

It is broken. And and the only thing that eventually helped me was when I got prescribed progesterone. I got progesterone, and for the first time, and by the time I got the progesterone, I hadn't slept for like two weeks. I hadn't slept well for like two weeks because I would wake up every two to three hours because of the pain. And I could only take so much NSAIDs, right? And I was like, you would just have to. I had different kinds of ad packs. I had different pack different types of warmers.

word, I know. Yeah.

All kinds of things to just help mitigate some of the pain. And the first time I slept well was when I finally took progesterone. And I was like, my God, this is great. And then I started noticing the other things that it was doing for me, my mood. I've always had insomnia. I was sleeping bad. I and I was like, my God. And then I started this journey, taking classes, you know, different trainings, different certifications to get really comfortable.

to be in this space. And you know, and I have to say unfortunately, I found myself in this space because of my own experience and and that's that's true.

Yeah. No. It's so true actually. I think that everybody I know in the space, either in the perimenopause, menopause or sexual medicine, like has their own impetus to be in it because because no one's helping anybody, right? So we have to help ourselves and so that's usually the first start. I mean I think people are obviously much more aware now and much more like, you know, willing to do the work. Yeah.

Yeah.

absolutely. absolutely. And I think that's just a reality in women's health. Like a lot of women, especially providers like you guys like you, are creating so much awareness, so much campaign to let women understand no one is coming to save us, right? We have to be willing to step out of the traditional outcome and say, I have to do something else beyond your prior medical history or beyond your fine. It has to be much more than that.

Yes.

Hundred percent, hundred percent. and then what when did you start your own practice?

So it's been four years now. So what is it, twenty six? So twenty what, twenty one? Twenty two. Twenty two. Yeah. Twenty two. Mm-hmm. Yeah.

Yeah. Twenty two. Twenty yeah, twenty one. Yeah.

wow, okay. and tell me how like you can't 'cause I mean that takes a lot too. I find like as someone who had to s did start her own practice, first in insurance and now not insurance, like how what what brought you to that point where you felt like this is what I need to do? 'Cause we we were talking right before like the the the the miseries that come with being a practice older, but the joys also that the freedoms that you have and everything like that. But I think that you know

You know what?

my

Yeah.

It's challenging, right? We we we never learned HR and and the business side of like what to do and all these things. So how did you come into that space or what made you come into this space?

So you know what? So before I started practicing as a nurse practitioner, I was a coach, right? And when I see people and they would come in. So I had some idea what, you know, cellular changes was and but

it wasn't really it wasn't something that we really paid attention to because we don't really talk about things like that, right? So when women would come in and they would talk about, you know, they were having some wood swings and things like that, I knew that it was, you know, biologically things were changing. I was a biochemist in Nigeria and I would say, you know, go to your doctor and, you know, let him

you know, check your hormones and things like that. But even then, I still was under the misconception that you have to be much older, like, you know, your period, you know, I was more about the menopause space, not the perimenopause space, right? So I would say, I know you're still saying your period, but these changes are happening. So you know, go to Obegaine and let him do like your hormone check and things like that. And people will come in and say, Well, my doctor said there's no specific tests for hormones. And and it's true, you know, because it fluctuates so much.

Yeah, yeah.

but there are other things that we can look at, right? Your thyroid, your inflammatory markers and all other things that can help guide us. And we already know perimenopause is a clinical diagnosis, right? It's not based off one particular test. And they will come back and say, Well, you know, my doctor's not helping, I can't get hormones and actually my patients were the one that was talking about like, I have a friend in Arizona. Arizona is very progressive for whatever reason because a lot of people would say, for what I'm telling you. I'm telling you I Arizona and California

Mm-hmm.

Really? my god.

some patients who come see me from Arizona, so

It's it's quite progressive, and it'll be like, you know, my my friend in California or Arizona, you know, they want to say HRT, but my doctor wouldn't prescribe it. And and I would keep telling them, and I was like, you know what? These women are just going all over the place trying to find somebody to help them. And I'm going through it myself. I know what HRT has done for me, especially for Gesperan. I can get into this space. I can do this. And I already know that there's so many limitations when it comes to women's health.

Yeah.

Because it's not we don't have I C D ten code for all of the things women experience, right? We don't have it. So I'm like, if you wanna do this then I have to do it on my own terms without somebody telling me what I can and cannot prescribe. So that's kinda how I decided that I was gonna go into private practice and I was going to

Yeah.

try to navigate it myself even though it was so terrifying because I don't really know anybody who had a private practice. that was my friend except the doctor's offices. So I was like, you know what? But I joined the elite NP group and it's a group, it's a phenomenal group for nurse practitioners. And that was where I got the the the balls from, for lack of a better word. that was where I found different nurse practitioners. The ovaries, yes. And I, you know, and then I found nurse practitioners doing great

Yeah.

okay.

Yeah. Ovaries. The ovaries.

wonderful things and honestly that was really what where I borrowed my spine from, if I must say, to to try to do it because there were so many people that were, you know, sharing that knowledge so freely and encouraging people to try. And I've always known, I mean, what is the worst that could happen? I have my license. If it doesn't work out, I can always get a job, you know. So I decided I was gonna give it a shot and here we are.

It is odd though. It it is odd. You know, every other day I'm like, should I just go clocking somewhere? You know, but it's so rewarding, it's so fulfilling and I I wouldn't change it for anything. Yeah.

R it's our

We were just talking about it, yeah, like you know, dealing with like, you know, employees in and out and you know absences and firing people and you know the issues that come up. It's very stressful. But and I don't think like people say, you you're probably making so much more I mean I don't I f I I probably work

Yes.

less clinically now than I used to when I was under an insurance practice. But it's not like, you know, I feel like there's so so much overhead and other things. It's not it's not a clear, you know, whatever. But I I like the fact that I have my my own freedom in my own schedule. So there's no cost to freedom.

Yeah. I I you know that's something that there honestly there really isn't. And and the thing about it is that for me, it's still something that I kind of battle with, right? because, you know, my my model is concierge, my model is pri private. And when I now when I decided that I was gonna get into this space, it was really to help people. It was really honestly to help many more black women, because we already have the distrust of the medical system. We already have all the biases and everything that we have to navigate.

And for me, I'm just at that point now where I'm like, okay, I might need to do things a little differently. I do I offer some pro bono services because I have people that just can't afford my services and they're suffering. I even even though sometimes I sit down with them and tell them what to tell their doctor and help them create a plan to help them navigate for advocate for themselves, they still come up and say, Well, my doctor still won't prescribe HRT. And so I find myself doing, you know, some pro bono to just help people get them started and hopefully

Hundred percent.

Yeah.

Yeah.

Yeah, same. I do some, yeah. Mm-hmm. Exactly.

You know what I mean? And then I'm like, okay, you know what? So I'm just at that interception of, okay, I have this knowledge, I have this compassion, I can help more people. But then you're just like, I still need to keep my business. I still need to be paid. I still need you know, so it's it's a battle that I go back and forth with myself, with what I intended to do when I started this journey. It's just right. Is it right? Yeah.

Exactly.

It's that internal conversation. I I feel it all the time actually. I some I sometimes like, okay, you know what? I was doing pri the insurance based model for eleven years and there was a time where I maybe got sixty percent of what I was supposed to collect and forty percent was like free service.

Yeah. Yeah. Yeah.

So you know what I'm saying? Because of either pati patients didn't pay or the or the insurance company. And so it's like, you know, you're at a point where like the the system is such that, you know, you may or may not get paid for a service that you already did. And that's that's what happened to me a lot because I didn't understand how to bill. I didn't understand, you know, I don't take people to collection. So that was something I was like, you know, not like the big system. So anyway.

Yeah.

Yeah exactly. Yeah.

Yeah.

Well, I wanna I wanna step into your mind and thinking about like take us into like what hap

I want to just understand some of the work that you're doing in Nigeria, and I want to understand you know the advocacy that you're doing. And really, you know, we have to understand that menopause is obviously biologically universal, you know, sex is biologically universal, but the experiences of all of this is not, and it's really in the context of different cultures, can be experienced so differently based on you know the lack of education that all women around the world get about.

their bodies, you know, including here in the United States. But tell me a little bit about, you know, what when you decided to do something back in Nigeria, like what took you back? What was what were you, what did you decide you wanted to do there? What was your, what was your like push to go back to do some work there?

So the push was the more women that I see. Actually, the initial push started from me showing up on social media. So when I started showing up on social media, I would have a lot of because I still have a a strong connection to Nigeria. My dad, my my brother, I have nieces and you know, family members in Nigeria. So the the change started from me showing up on social media and talking about it. And I would have people from Nigeria slide into my DM and say,

Yeah.

we thought this was a white white people problem. And I'm like, no, it's not. It's not. Because they there was this disconnection. Yeah, they thought menopause was. They thought that menopause and parameters was a white person problem because whenever they heard this conversation, it was coming from someone who was either Caucasian or an American. So there was this dissociation that it's not, it's not it doesn't affect us. Right. And I and I said no.

wow, really Yeah. They thought menopause was?

Interesting. Yeah.

It's so true. Yeah. It doesn't affect us. It doesn't affect us, yeah. That's why we need voices on the stage. You know what I'm saying? Yeah.

Absolutely, absolutely. That's why diversity is very important, right? And and I was like, no, I and I and then I I took myself back to when I lived in Nigeria. I left Nigeria when I was like maybe twenty-five or twenty six. And I remember that we would see older people. Nigeria is our culture ages people out. Okay. We we practice ages in a lot. And I don't think it's intentional, it's just a cultural norm. Once you're like forty, you're considered old and mm mm.

really? I wouldn't have thought that. Okay, that's so interesting.

Yeah, once you're like forty, you're considered old and you're kind of limited from you know some of the participation that you can do, even at work. Now we do respect our elders, so it presents in different ways, but it's also very limited. absolutely. It's a culture of like I'm your I'm Yoruba, I'm from the southern side of Nigeria. So our culture is a culture of respect, right? So we respect our elders and all of that. But like I said, it still comes with some social constructs that just

That's what I was gonna say. I thought there was like a culture of really respecting

Sure, sure.

limitations, yeah.

limits, you know, different ages. And and I took myself back to Nigeria and I'm like, we I never heard, you know, menopause. I never heard perimenopause. And I never heard my mom talk about it. It wasn't something we talked about. It was there's so much stigma to women's health. We don't talk publicly about menstruation. We don't talk publicly about sex. We don't talk publicly about the changes women experience. We don't. It there's just so much shame. We we don't.

Okay.

So much.

Yeah. Yeah, you're right. Like even menstruation is like so taboo in most countries. Yeah.

No, we we don't talk about things like that. And I and I when I started getting all these DMs of people coming in saying, So, you know, when I sleep at night and and I wake up and I'm drenched in sweat, you know, is that what it is? They had no idea. They had no like we have names for all of these things because Americans are, you know, medically aware.

You know what I mean? Like we we have so much knowledge, we have so much resources. Like our kids are involved in their healthcare from when they're younger. I have one of my sons that has allergies. From when he could talk, it could tell you what allergies he has, right? What what food or what medication is allergic to. In Nigeria, I could never tell you what was wrong with me. You would you went to your doctor, they gave you medications. You don't know the name of medication. Sometimes you might not even know your diagnosis.

Yeah.

You just go out, you buy the medication, and that's it. You you can't even advocate for yourself and tell what what history you had, except if you had a surgical procedure. That's the only thing you probably know. So it's so different how we practice and how we pass information from our patients. We don't do a lot of patient. No, we it's just different. Anyway, so they started getting my DM and they were describing half flashes, then they were describing night sweats, and they were described and they didn't have a name for it.

Yeah.

You see what I'm saying? They didn't have a name for these symptoms that they were experiencing. They were describing the mood swings, brain fog, which they just thought it was aging. And I'm talking about people in their early 40s. Like it's not, it's not like they're old. But because we've always heard, yeah, it's just part of aging. Everything is associated with aging. It doesn't matter. yeah, but it's just aging. It's just aging. And they didn't have a name for it. So I started giving them the names. I started naming the symptoms. I started experienced in my DMs.

Is there a w is there a phrase for menopause in Nigeria? Or in in your is there a phrase for menopause in your in your native language? Nigeria yeah. Yeah. Mm-hmm.

Is that what?

No, no, we don't have a phrase for it. We don't have a phrase for it. So I started, you know, we'll get on WhatsApp and I would tell them, you know, what these symptoms mean, what we call the symptoms and all of that. And I thought, huh, these are educated girls. You know, these are my friends that are executives. Like they are eye-function executives. They had no idea what this is. And that was what started planting the seed in my mind.

Yeah. Yeah. Yeah.

You know what, if we as Americans are struggling in this great healthcare system, in this advanced healthcare system, and women are having difficulty being listened to, and women are going from four to five providers before they find someone to help them. What does he even tell me as an average Nigerian who, number one, we don't

Yeah.

We don't have the willpower or the freedom to really advocate or challenge your doctor. We we don't have that. It's not you're not expecting to just go against no, your doctor tells you this and that's it. You say yes, you go away. Like it it's a different system entirely. So how much more that society w well, it's completely patriarchal. And then we have the misogynistic part of it. So it's it's a combination of both, right? And that's that's why I s I went to do that campaign, to at least open people's minds up to

Yeah. Sure. More patriarchal. Yeah.

What could be going on, the changes that we're experiencing, and and what we can do about them. Because everybody goes to the doctor with joint pain, with nightswear, and they're just like, it's malaria, or it's typhoid. So they're taking all these medications that are not doing anything for them because nobody connected the dots to say this could be perimenopause or menopause. Like there's just a huge disconnect from after you've had your baby to what goes on. Absolutely. Absolutely.

wow. Yeah.

So they're getting treated for like malaria and typhoid when they need estrogen. wow. Yeah.

I like my auntie, my mom called me one year, she was like, you know, your auntie has been complaining about, you know, this joint ache and she's you know, sweating all day and all that. And I'm like, I know she's a menopause, that's what it is. And she's been to the hospital, she was admitted, she was decided malaria, is typhoid over and over and over until I put on an estrogen.

Yeah.

saying this is something it's a huge problem because we talk about access all the time. Well, access presents differently in different regions. It's not just access to the doctors, it's access to the education, it's access to the knowledge, it's awareness, right? Because when it

Or even the hormones, like how how accessible is estradiol patches and barely.

It's it's barely accessible. Barely accessible y because no one sees it as a problem, right? No one sees it as a problem. So most of these medications that I eventually give to these patients would have to come from Europe or from the UK or from India.

Mm, yeah.

Yes. That's what I that's what I have to do when I treat patients in Pakistan or other countries is like we have to

Exactly. It has to come from and it's so expensive, right? Because nobody's subsidizing these medications. And you have to pay for them in dollars. And then the Naira, it doesn't really have a lot of value. So it's too expensive. So already that already limits who can access these medications. So we find I find me myself using you know supplements for these people. You know, okay, let's take magnesium. Okay, let's try some this. But nothing, nothing, I'm telling you, nothing works as effective as

So it's possible.

That black hair.

when we eventually have access to HRT. And sometimes they have to stay for it, right? Sometimes we know that that is where we're going to end up at, but they can't afford it at that point. Okay, so let's use different things to kind of help us. Eventually when they get estrogen or progesterone, it's life changing. So that's why for me I have a different perspective because it's not just about let's just use HRT. We have instances where we don't have HRT, where we have to do other things, but nothing provides relief as much as HRT in the right candidate.

Yeah.

Sure. Yeah.

What do they are are most of the patients you're talking to or or friends and family, are they amenable to taking hormones or do they feel like is there a taboo like on top of that associated with like menopausal hormone therapy? Yeah.

Absolutely. Absolutely. So there's a taboo with menopause on therapy because even though they're just learning about menopause, they know that some of this can they've heard that it can cause cancer, right? So even though they're just learning about it, they know some of it can cause cancer. So we're dealing with that. Also, when you talk about a patriarchal society, the decision is not always from, it's not always the woman's to make. She has to sometimes take permission from her husband.

Yeah.

To be able to, even though it's a medical history, it's a medical diagnosis, it's not, it's not like, okay, well, I'm sick and my doctor prescribed I have to, unless it's like malaria and typhoid. We have women. I'm talking about many women that are dying from cancer because their husband opposes them taking treatments, their husband opposes chemo, their husband opposes conventional medicine, they want them to use herbs or something. We have women dying from cancer because.

Yeah.

Yeah.

My god.

Of their husband's disapproval. So this is beyond you can even access this medication. This is beyond I have the awareness, I can I even want to take it. A lot of women, even sometimes, sometimes it's financial because their husband has to pay for it. But I've always I've also come across women who can afford to pay for them, who can afford to pay for it, who still need the permission of their husbands before they take it. And I've had women say, No, my husband said I don't need it.

My husband said I should just use diet and and exercise. And that's all they've decided to do. And they are the ones suffering. They're not sleeping, they have mood swings, they vaginal dryness. All of those things are going on with them. But they have refused to take treatments unless their husband approves it.

Do you?

Are you having many conversations with them about sex and gen GSM and all of these things as well, or is that still yeah?

Absolutely, because they're all experiencing it. They're all experiencing it. You know? And then un unfortunately because and it goes back to what I said from what the culture allows. Once you're like fifty, they don't expect you to have sex anymore, right? So

Yeah.

Of course, yeah. Mm-hmm.

You know what I mean? So you don't even you don't even have to say it out loud that I wanna have sex, you know, that I my libido is gone because they're gonna ask you what what are you using the libido for? You know what I mean? Like what do you mean? I'm only fifty. No. So this is the thing that kinda snowballs out of place. So for me, when I ask them, okay, what's your libido like? And she's like and they even reluctantly, grudgingly say to me, I mentioned it because I'm very open minded about it and we talk about it. And then they finally open up, say, Yeah, I want to, blah, blah, blah. But because a lot

Yeah, exactly.

Yeah. Yeah.

Because again the site is different, the the norms are kinda different. So, you know, the men are able to get away with a lot and the women just learn to live with it and they just accept it.

Sure.

Yeah.

What are ha what's happening to the men? Like are they probably easily accessing Viagra somehow when they

You know, because even be beyond Viagra, we've always had herbs that are sold publicly for men's libido and sex drive, you know. So most of them don't even need to they have all these people aucing herbs all over the place. And and then you you wonder because like I said, it's a different kind of societal norms that we sort of accept. And because women have be conditioned to do whatever it takes to stay married, because marriage is a huge part of our culture.

Yeah, sure. Yeah. Yeah. Yeah.

Course.

And divorce is frowned upon regardless of why the divorce happens. So these women, so so now imagine, and I don't want to, you know, say it aloud because I don't want my Nigerians to be upset with me. So imagine the men have access to get all these herbs that that allows them to continue to thrive, and the woman is not getting any. Okay. And then even if she wants to, it hurts because you know it's dry.

Hundred percent.

Why, exactly. Yeah.

Yeah.

Uh-huh.

And she's not, she's not in a position to advocate for ourselves and sell publicly or privately with our doctors to say, hey, I need help, can you help me? So and then demand is still is getting some from somewhere, but not necessarily from the woman, right? But it's somewhat nobody talks about that part. No, no, no, those are the silent things that we just you know what I mean. So so now tell me, if I have to ask you.

Nobody talks about that, yeah. Yeah. You ever we can read between the lines here. What's happening?

To get permission to get help for my libido or to get help for my dryness so that that way we can be more intimate. But you don't have any any reason to support that because you're okay. What you see what I'm saying? So the dynamics is very different. So a lot of these women are coming behind their husbands to get help, to get resources to kind of help them. The ones that are bold, the ones that are like, okay, you know what, I'm not just I'm not gonna take this.

The if so despite their husband's disapproval, they're getting some. But the problem is because once you're like fifty or even forty five, even your husband is not really attracted to you in that realm, sometimes the w women don't even want to pursue enhancing their libido because how are they gonna who's gonna help them? What are gonna do out of what are they gonna do about it?

Yeah. Yeah. Who's gonna help them there? Yeah.

encourages and doesn't encourage. And you know, when I started seeing a lot of unconsummated marriages among my Muslim couples, I, you know, tried to go, this was like in twenty fifteen, twenty sixteen, I used to have these flyers that would say, like Ease Mubarak and do you have an unconsummated marriage? Because I'm happy to help. Right. And I remember taking to this masjid and they were like sister. La la la Like they were like GTFO, right? Like they were like I got

my God.

Yeah. Yeah.

So I mean I tried for a few years. This was like over a decade ago. Maybe I should try again, but you know, I don't you know. The thing is is like there was a lot of pushback here in the America, in downtown Chicago, in like the local mustjids. And this is a problem that our community has. And I'm trying to say, like, you know, we have solutions and I'm talking about it. I my my my flower is like, we're talking about it, right? And it's like and talk about like eat the mabark.

Yeah.

We're finally talking about it. Like, do you have an unconsummated marriage? Are you suffering from blah blah blah? And they were just like, really? And so I I left I was like, well, can I just leave the flyers here to see? You know, they can like take a look. And like they were just trashing my flyers. Like.

Yeah.

And that's and that's also, you know, a big part of the problem is Nigeria is also a religious country. You know, we have so many Christians, we have so many Muslims, and then we have, you know, the in-betwins. And it's religiously diverse, very diverse, but it's not it's so diverse, but you still can't publicly talk about sex. You you cannot, you know, you you can't talk about there's such a stigma to conversations like that.

Yeah.

Yeah, it's religiously diverse too, right? It's very diverse religiously. Yeah. Yeah.

Yes.

Because that's the culture. That's the culture of

Because of the culture. So when you have a country that is religiously diverse, culturally diverse, right? And everybody's trying to find a medium, it it's it's very challenging. It's very challenging. And then you have different cultures and we promote it's there's so many stigmas and so many shames that we promote that makes people just eyed and not really talk about what's going on. So even during my consultation with those women, sometimes I have to

Yeah. Yeah.

connect with them few more times before they feel comfortable to kind of tell me what the concerns are because they still see me as a Nigerian. You know what I mean? It helps that I'm, you know, Western trained and all that. So it helps they feel comfortable with that because they know that their information will be private, it will be protected, but they still see me first as a Nigerian. And they have to make sure that they are safe to have those conversations with me.

Talking to you. Yeah. Yeah. Yeah.

Yeah. Yeah.

Yeah. Yeah.

Yeah, yeah.

That's great. Well, you mean this is great. I mean, I love that you're doing this because I think that, you know, you're gonna empower some people to and you know, it takes a long time for, you know, any cultures to change, but if you can empower a few women to try to like do better, I mean, what are you seeing in term just before I talk a little bit more about that, but what are you seeing in terms of even like perimenopause and menopause? Because I had this amazing doctor, Sadia Malik, who does work in Saudi, she's Pakistani on my podcast, I think last

Year and she told me about all the POI that she sees, like from either cancer survivors in these countries, or just that these women are having early or like less than age 40 menopause. And some of that I think is of course, like you know, the weathering and the all the things that we know, and then some of it is like, okay, these were cancer survivors who got forced into an early menopause. Are you seeing that as well? Do you see like patients who are less than 40 that are experiencing symptoms that you think are you know POI?

Why are paramenopause or even you know earlier than average menopause?

I do, I do, I see that. I I can even say, you know, most recently a majority of my patients are, you know, between thirty five and forty experiencing POI. And unfortunately because our culture is also huge on childbirth, right? if you don't have children of course.

Mm-hmm.

they're stigmatized even more.

my god, it's it's a huge stigma. So and that's additional stress for this for these women, right? Because they're trying so hard to conceive and they cannot because they have all these, you know, puis and those fertility challenges. So when you start to talk to them, and that's why perimenopause for them is so frightening, because they cannot afford to think that they are approaching menopause.

When they're still trying so hard to conceive. So for them, once you start to say, maybe it's Omona, they will start to rebuke it. They will tell you, God forbid, that's not that's not my passion. You know what I mean? And you have to respect that because I understand where they're coming from. I know that their number one priority is to conceive. So they don't even want to talk about Omona changes, right? All they're worried about right now is this POI, how can we make it better? Unfortunately, we have.

Yeah.

limited resources in Nigeria, unfortunately. So it it's so much that is, you know, working against women in that region. And and I'm and I'm sure it's not just Nigeria. And I'm sure it's, you know, most African countries. You know what I mean? Outside, exactly. Outside of the developed countries like you know, United States, Canada,

Yeah, yeah.

No, of course. It's it's global. It's a glo you know, right. I mean we have we have areas in in the United States. I mean women are still dying three times the rate of child birth black women in the United States. I mean, so like we have our own issues obviously, that are because of sexism and racism within our own medical system, but

Yeah. Yeah. Yeah.

Yes. Absolutely.

I mean, do you think that okay, so now you're saying so for a long time menopause and this phrasing wasn't even there was no vocabulary for it, but now we're seeing more people get vocabulary for this. And so when they think about menopause, are they just thinking, my god, I'm just like the old woman now that's gonna get put aside? Or are they thinking like, I've lost my femininity, or is it more like, this is just normal part of aging? Like where where where do you think the culture lies, or is it a combination?

Mm-hmm.

Yes.

So it's a combination, you know. So t telling them that they have menopause right now puts them in that, my God, I'm aging out of society is bad enough as it is. And they're worried about that workplace too. And then it's also, okay, what what can I do about this? Because I'm not I you know, I still want to stay young and all of that. So they're still worried about the stigma of I don't want to take medications as well. You know, like they associate taking medications to being sick and you know, it doesn't matter. And I'm like, so the education is changing.

Mm-hmm.

Because a lot of them are now being more open to taking supplements. So now I kinda eyed under the umbrella of the supplements. I'm like, it's not a supplement. It's almost like supplementing what we're losing, right? So it's not changing how you're aging, right? It's just to help optimize aging in different ways. So some of them are kinda like they don't want it. Like I said, our culture respects the elderly, but they have different limitations that they have to now accept, right? That okay, now I'm menopause or now I have to accept my fate. Now I have to accept that I'm finally old and

Yeah.

Yeah.

There's no coming back from this. So it's a combination of different emotions of okay, what do I do about it? And because it's still a new conversation that we're having, a lot of them don't really know how to feel about it. They don't know how to navigate it. And I think because we also don't have the hormones readily available and all these other tools that we have here, that also minimizes the kind of experience that they can get. Because sometimes I have patients that are on HRT for a while, they're doing well and they feel great. And then of a sudden we can no longer

access it, like it's out of stock, we don't have it, and now we have to go months without this medication. Now it's it it goes back, you know, it it's it's just a lot. It's just a lot.

Makes it.

What what do you find about like are you working with other clinicians in the area? Like how do the doctors in Nigeria are they now speaking about it, talking about it? Are you seeing that? Are are you able to get into the the hospital systems to see what's being discussed in terms of women's health? Is it is it is there any progress? No.

No. No. That no, no. Nigerian hospitals are very the doctors are it's it's different. They're not willingly, they're not receptive to this kind of information yet. You know, they have like I said, it's a patriarchal society. So it's almost like, you know, you can tell us what to do, you can tell us how to run the clinics, you can't so it's very different. So they're not receptive to this information. They they don't you know, they just think women should just deal with it.

Yeah, yeah.

Unfortunately that's our majority of the hospitalists feel about it. And and I think this education that women are able to access on social media is helping a lot because a lot of Nigerian women are able to, you know, travel to different places and and things like that. And I think access to this kind of information is empowering them to be able to advocate for themselves and say no. We we don't have to just suffer through it. We have different resources and we need you to help us with it.

Yeah.

Exactly.

So I think that's one thing social media is really helping with. And that's why I have two different pages because the information is different. deliver delivery is different. And and I want them to and I don't want to have to explain myself after every five seconds because we're like I said, we're culturally, we are medically literate in the United States and we're not. So the information is has to be delivered differently. And I've seen so many people come back to me.

Yeah.

Amazing.

Yeah.

Sure, sure.

to say, my God, I was able to talk to my doctor about it. We don't have hormon I mean, we don't have ex access to estrogen or progesterone, but at least maybe we can use some bird control pills. You know what I mean? So there are different things that we can kind of help with something, something that we have access to that we can use, you know, in lieu of HRT. Now is it gonna be the same? No, it's not. But it's gonna help with some of those, you know, symptoms that they're experiencing. Exactly.

Yeah. Something. Yeah.

Just a different form of it, I guess. I mean the thing is I think what's you know, what's very important is and

Is that you know, once especially the patients, you know, experiencing POI, it's not just a reproductive phenomenon, it's a cardiometabolic phenomenon, right? And even the people that are going through menopause so early who are suffering through sleep and hot flashes and the vasomotor symptoms, you know, that's a sign that we need to treat this because, you know, and and you and I know this, but for the ones that are listening that are hesitant to try to even treat it in any capacity. I mean, I think there's been some studies showing that even if you treat your vasomotor symptoms with something other

Than estrogens, which is the gold standard, that you can get some you know significant benefit from you know a cardiovascular and metabolic perspective, right? And so that to leave untreated symptoms, to leave sleep untreated is not just a quality of life issue. It is a longevity issue, it is a health span issue, right? So

Absolutely.

Absolutely. Absolutely. And that's the other challenge that I'm having to navigate is to open their minds to using birth control pills in the absence of homotherapy. Because you already know, you know, that most of them are thinking, well, I'm not, you know, I'm menopausal, I'm not bleeding, I'm not menstruating, I'm not

I'm not even having sex.

Exactly. So now I'm having to, you know, educate them now, yeah, in lieu of this, this is what we can use to help with some of their symptoms. And it's just it's just different. Like I said, it's I'm so happy that a lot of them and and then it's it's also so so encouraging because usually, you know

Back then our moms didn't have access to be able to navigate social media. So the fact that some of them are actually on social media and consuming some of this information and their kids are sending these reels to them to say, Hey mom, I think this is what's going on. It is so empowering, it's so encouraging to, you know, it just allows you to show up because I get all these DMs and I get all these WhatsApp messages and it's so

I love it. Yeah.

Yeah.

Yeah.

It's so uplifting to know that eventually, you know, people are, you know, finally learning about these things, having names, you know, for us this symptoms that they've been experiencing beyond, my god, I thought I was having cancer. I thought it was cancer. I thought I was gonna die. And it was just our flashes and eyesweeds, you know what mean? So it it's it's been such a fulfilling journey for me.

Exactly, yeah.

I love it. And I think, you know, this is the this is this is women pushing for advocacy. This is us trying to put push the the envelope

you know, to to make sure that we get the kind of health care and and really care that we need for our own bodies. So I think this is wonderful. what is your like we I call it the vagilante verdict because my husband calls my listeners vagilantes. But what what's your hot take? What's your hot take or vagilante verd? Like what do you want the listeners to hear? I mean I have clinicians that listen. I have so like what what should they understand about, you know, if they have a Nigerian immigrant that they're trying to nego

Ha

negotiate, you know, discussions with. What about, you know, what do you want your the patients out there listening to hear and understand? You can go first one and then the other, but but but tell us what you think.

Yeah, for the patients I want you for any Nigerian or any African or anybody in a in a different kind of societ society, what I want you to learn is that you know we don't need to suffer. We have so many resources that can help. And sometimes it might not be hormones, sometimes it might be birth control pills, and they have different roles that they play in the overall cardiometabolic profile, in longevity, in helping with some of these symptoms that you might be experiencing. And I want you to, when you're talking to your doctor, I want you to continue to advocate for yourself and put

shame asha aside. I know that yes, we have so many stigmas that surrounds the way that we talk about our medical our concerns, but we have to be willing to step out of those and unlearn some of those behaviors. And so that way we can advocate for ourselves and continue to thrive at any age. that's one thing I would give the patients. And for the clinicians too, we have to be open minded. there's a lot of ego when you're dealing with

Nigerian doctors and Nigerian clinicians, we have to be open minded in l learning and on learning some of the norms that we think that we have. paramenopause and menopause takes much more than what a lot of people learn in, you know, in medical school or nurse practitioners or whatever. but we have to be willing to step out and learn from our colleagues. And if we don't know, that's okay. We just have to be willing to refer. Telling the patient that they have to suffer through it and it's just what they should endure as a woman is is not okay.

It it really isn't because we have so many tools that can help these women, that can help them alleviate some of the symptoms that they could be experiencing.

Hundred percent.

And if you are, you know, an American clinician here and you have a patient from Nigerian descent in your office who you're trying to encourage in some capacity, just understand that people, you know, like you have to meet people where they are and then, you know, educate them in the way that you wouldn't anyone else, and then try to s you know, see if you can help them destigmatize these issues so that we can have, you know, these open conversations and and they can come forward and and really

Do you think is there a lot of mistrust there in the medical system as there is here? No, not as much. Yeah. Yeah.

yes. my god. Absolutely. I I think it might even be worse because we don't really have the kind of accountability that we have here. You know, here after a medical negligence, you know that if you know you can pursue justice, you can't over there it it's not. You're gaslighted into letting it go, it's an act of God. It it's just me what's meant to be, you know what I mean? So we don't have that. There's a huge mistrust of the medical system over there.

Yeah.

Yeah, that's true. That's true.

Yeah. And I think religiously we we convince ourselves that this is God's will and you know, all the things like Yeah. Yeah. Yeah. Yeah.

And that's why said it i it's an act of God, it was meant to be, and you know, just let it go so you can have peace and you're just gaslighted and not just the medical doctors, your family members, your friends, everybody just expects you to just let it go. So there's a huge mistrust, a a huge one. It's it's unbelievable. Yeah.

Yes. But

Yeah. Well this has been so insightful. If you want to assist this has been great. I you know, love actually, you know, when I see your videos of you going to like, you know, in the Nigerian radio shows that you grew up listening to I mean I I thought that was such a great moment for you as well. I mean just the work and it's you know, you are doing the Lord's work and this is amazing and I love the advocacy and really just giving the voice to you know, you're so right, like

my god. It if we are real.

Okay.

The fact that they didn't, you know, that patients don't even recognize that this is something that they can experience because they don't see people like us talking about it enough, right? And so I think that, you know, this is one of the reasons why we have to use our the lens that we come from to really talk about some of these issues and and our experiences and try to like, you know, again, destigmatize the shame that every culture has around genitopelvic issues, right? Like this is a universal font phenomenon, and we just need to make sure that people

Mm-hmm. Yeah.

Yes.

People have the language to talk about it, and people can then advocate for themselves as they do.

it that's it you've you've said it right it's really just you know destigmatizing a lot of this norms that a lot of people grew up with and looking at it from a different lens you know what I mean to to to meet people where they are you know because you can't change people overnight like when when I have some of my Nigerian patients and we're talking about diet we're talking about insulin resistance and all that

I'm not telling them not to eat rice or remove carbs. They're not gonna comply. You know, diet is a huge part of our culture. So what we can do is modify it to maybe instead of every day, maybe three times a week. Maybe, you know what I mean? And then when we're looking at insulin resistance too, in someone who's Asian or someone who's African, we have to look at it from a different lens.

Yeah, yeah, yeah, yeah.

Yeah.

Yeah.

Because of our complex gaps, you know what I mean? Like we can't just go off of this is what the number says that no, we have to look at the old metabolic profile, the lipid profile, everything else, in addition to that, to be able to have a good gris of what's going on because of our diet, right? So it's just different, it's not black and white, it's not cookie-cutter, it's not the same from for everybody. We all have different, you know, life issues.

Hundred percent. Yeah.

Yeah.

Yeah.

Yeah, yeah.

of life experiences that has taken us to where we are and we have to include all of those in our outcome overall. So it's just beyond just diagnosing, you know, hypertension or diabetes when we're talking about parameters and menopause. It's much more than that. And we just have to be willing to look at it from a different kind of lens.

Hundred percent. Hundred percent. Well thank you so much, sis. This has been great. I love you. I love everything you're doing. I appreciate you and thanks for coming to educate us and giving us, you know, a a beautiful perspective on the things, not the only things that you're doing, but the things you're trying to change, which is great.

Mm.

Yeah, thank you so much for having me and thank you for this wonderful podcast. Honestly, I the podcast is one of the ones that I always send to my patients. So sometimes they're like, yeah, but I listen to I'm like, you know, listen to this podcast 'cause she brings all kinds of people. She's brown, she understands it, she's Indian, she's they have cultures that kind of Pakistanic. Yeah, my bad. She's Pakistan, they have

Yeah.

Pakistani. Stay Osaka.

cultures that are similar to what we experience too, right? And and I and I tell me something I'm like, listen to all of these things. Empower yourself. You don't necessarily have to do anything right now, but I just need to empower yourself. So thank you so much. I love I love you. Love what you're doing. That's it. That's all we're trying to advocate for. Open up your mind. That's it.

Just open your mind. Thank you. That's all we're trying to do. And you know, as I say, we're here to educate so you could advocate for yourself. That's it. Yeah. Yes.

That's it. Because how many patients can we possibly see? How many? But if we give you the tools to advocate for yourself, then you can find what you need from any clinician that's willing to listen. That's it.

Mic drop. Okay. all right, thank you so much. thanks everyone for listening to Guy No Girl Presents Sex, Drugs and Hormones. I'm Dr. Samina Rahman. Again, we're here to educate to so you can advocate for yourself.